Provider Demographics
NPI:1093464398
Name:NOUR, MONA (DO)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:NOUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8777 BROADWAY AVE
Mailing Address - Street 2:PAVILION C
Mailing Address - City:MERILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-738-5325
Mailing Address - Fax:
Practice Address - Street 1:8777 BROADWAY AVE
Practice Address - Street 2:PAVILION C
Practice Address - City:MERILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-738-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02008558A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine