Provider Demographics
NPI:1588635809
Name:NEMUNAITIS, BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:NEMUNAITIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-761-7281
Mailing Address - Fax:216-761-7257
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 304
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-761-7281
Practice Address - Fax:216-761-7257
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005876207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017202580001Medicaid
PA021236SY7Medicare ID - Type Unspecified
PAG57926Medicare UPIN