Provider Demographics
NPI:1164464269
Name:NEMUNAITIS, JOHN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:NEMUNAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-6644
Mailing Address - Fax:419-383-3339
Practice Address - Street 1:1325 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8009
Practice Address - Country:US
Practice Address - Phone:419-383-6644
Practice Address - Fax:419-383-3339
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3859207RX0202X
OH35.132707207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134352702Medicaid
TX134352706Medicaid
TX134352705Medicaid
TX134352701Medicaid
TX8R1513OtherBLUE CROSS OF TEXAS
TX134352702Medicaid
TX85M499Medicare PIN
B66072Medicare UPIN
TX134352706Medicaid