1184116220 NPI number — DAVID PUYRAIMOND ZEMMOUR MD, PHD

Table of content: DAVID PUYRAIMOND ZEMMOUR MD, PHD (NPI 1184116220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184116220 NPI number — DAVID PUYRAIMOND ZEMMOUR MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUYRAIMOND ZEMMOUR
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEMMOUR
Provider Other First Name:
DAVID
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184116220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
924 E 57TH ST
Provider Second Line Business Mailing Address:
BSLC RM R214
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-834-4878
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
924 E 57TH ST
Provider Second Line Business Practice Location Address:
BSLC RM R214
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-834-4878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X , with the licence number:  036.162982 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com