Provider Demographics
NPI:1518020288
Name:NEMECEK, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:NEMECEK
Suffix:
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 1:11095 VIKING DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7223
Mailing Address - Country:US
Mailing Address - Phone:952-996-3295
Mailing Address - Fax:952-996-2599
Practice Address - Street 1:11095 VIKING DR
Practice Address - Street 2:SUITE 350
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7223
Practice Address - Country:US
Practice Address - Phone:952-996-3295
Practice Address - Fax:952-996-2599
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN361892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry