Healthcare Provider Details

I. General information

NPI: 1588635809
Provider Name (Legal Business Name): BRIAN NEMUNAITIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEVERANCE CIR SUITE 304
CLEVELAND HTS OH
44118-1566
US

IV. Provider business mailing address

5 SEVERANCE CIR SUITE 304
CLEVELAND HTS OH
44118-1566
US

V. Phone/Fax

Practice location:
  • Phone: 216-761-7281
  • Fax: 216-761-7257
Mailing address:
  • Phone: 216-761-7281
  • Fax: 216-761-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number34005876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: