Provider Demographics
NPI:1477684074
Name:MIGUEL, NEMESIO L JR (MD)
Entity Type:Individual
Prefix:
First Name:NEMESIO
Middle Name:L
Last Name:MIGUEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E STATE PKWY
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4538
Mailing Address - Country:US
Mailing Address - Phone:847-885-5264
Mailing Address - Fax:847-755-5170
Practice Address - Street 1:506 E STATE PKWY
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4538
Practice Address - Country:US
Practice Address - Phone:847-885-5264
Practice Address - Fax:847-755-5170
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36107557207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG48497Medicare UPIN
ILL93010Medicare ID - Type Unspecified