Provider Demographics
NPI:1437297256
Name:NEMECHEK, PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:NEMECHEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 N. VERRADO WAY
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396
Mailing Address - Country:US
Mailing Address - Phone:623-208-4226
Mailing Address - Fax:866-480-0357
Practice Address - Street 1:4252 N. VERRADO WAY
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396
Practice Address - Country:US
Practice Address - Phone:623-208-4226
Practice Address - Fax:866-480-0357
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005424207R00000X, 207R00000X
KS05-23671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO247914401Medicaid
KS100237220BOtherMEDICAID
E56236Medicare UPIN
MO247914401Medicaid