Provider Demographics
NPI:1184624041
Name:ESEMUEDE, NOWOKERE (MD)
Entity type:Individual
Prefix:DR
First Name:NOWOKERE
Middle Name:
Last Name:ESEMUEDE
Suffix:
Gender:M
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:PO BOX 11406
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:321-752-1540
Mailing Address - Fax:321-752-1558
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8662
Practice Address - Country:US
Practice Address - Phone:321-752-1540
Practice Address - Fax:321-752-1558
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1113752086S0129X, 2086S0129X
PAMD43426622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004201900Medicaid
FLFP104ZMedicare PIN
MOP00177648OtherRAILROAD MEDICARE
MOG46563Medicare UPIN
FLFP104ZMedicare PIN
MOG46563Medicare UPIN