Provider Demographics
NPI:1578578068
Name:NEMEC, GLENN G (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:G
Last Name:NEMEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:1001 HART BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8670
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN31329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN089004253Medicare ID - Type Unspecified
MND75426Medicare UPIN