Provider Demographics
NPI:1932614062
Name:EMD LIVE LLC
Entity Type:Organization
Organization Name:EMD LIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:M M NOOR US
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-762-4843
Mailing Address - Street 1:7349 TESTIMONY AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-4684
Mailing Address - Country:US
Mailing Address - Phone:346-208-2408
Mailing Address - Fax:
Practice Address - Street 1:1955 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4456
Practice Address - Country:US
Practice Address - Phone:317-762-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01075046B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty