Basic Information
| Provider Information | |||||||||
| NPI: | 1164464269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEMUNAITIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3355 GLENDALE AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193836644 | ||||||||
| FaxNumber: | 4193833339 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 CONFERENCE DR | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436148009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193836644 | ||||||||
| FaxNumber: | 4193833339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 01/22/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | J3859 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RX0202X | 35.132707 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 134352702 | 05 | TX | MEDICAID | 134352706 | 05 | TX | MEDICAID | 134352705 | 05 | TX | MEDICAID | 134352701 | 05 | TX | MEDICAID | 8R1513 | 01 | TX | BLUE CROSS OF TEXAS | OTHER |