Provider Demographics
NPI:1245556810
Name:MIKA NEMETH, EMILY SIGNE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:SIGNE
Last Name:MIKA NEMETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:SIGNE
Other - Last Name:MIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1711 CLEMENTS FERRY RD UNIT 112
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8717
Practice Address - Country:US
Practice Address - Phone:843-606-7893
Practice Address - Fax:843-402-3456
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37434207Q00000X, 207Q00000X
IL036132871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC374348Medicaid