Provider Demographics
NPI:1467526970
Name:JEMMY-NOUAFO, ARMELLE Y (MD)
Entity Type:Individual
Prefix:
First Name:ARMELLE
Middle Name:Y
Last Name:JEMMY-NOUAFO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 ORANGE PL STE 2400B
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4478
Mailing Address - Country:US
Mailing Address - Phone:216-896-1844
Mailing Address - Fax:216-201-6061
Practice Address - Street 1:3909 ORANGE PL STE 2400B
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4478
Practice Address - Country:US
Practice Address - Phone:216-896-1844
Practice Address - Fax:216-896-6061
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078854207Q00000X
OH35-098977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080H262390OtherBLUE CROSS-BLUE CROSS
MI466129510Medicaid
AJ078854OtherCHAMPUS-CHAMPUS
MI466129510Medicaid
0H26239174Medicare ID - Type Unspecified