Basic Information
| Provider Information | |||||||||
| NPI: | 1215198619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEMON | ||||||||
| FirstName: | NABEEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
| FaxNumber: | 7275447389 | ||||||||
| Practice Location | |||||||||
| Address1: | 6006 49TH ST N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274902100 | ||||||||
| FaxNumber: | 7275447389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33268 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 33268 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 33268 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 019194800 | 05 | FL | MEDICAID |