Provider Demographics
NPI:1043290125
Name:NEMICKAS, RIMAS J (MD)
Entity Type:Individual
Prefix:
First Name:RIMAS
Middle Name:J
Last Name:NEMICKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3436
Mailing Address - Country:US
Mailing Address - Phone:773-355-5300
Mailing Address - Fax:773-714-1353
Practice Address - Street 1:1550 BOYSON RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2362
Practice Address - Country:US
Practice Address - Phone:319-743-7300
Practice Address - Fax:319-743-7311
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.093412207L00000X
IN01078992A207L00000X
IA32843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA190231Medicaid
IA190231Medicaid
IA48999Medicare ID - Type Unspecified