Provider Demographics
NPI:1912065491
Name:NEMEROVSKI, RANDALL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:NEMEROVSKI
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 1:7300 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-6525
Mailing Address - Country:US
Mailing Address - Phone:262-321-6060
Mailing Address - Fax:
Practice Address - Street 1:7300 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406
Practice Address - Country:US
Practice Address - Phone:262-321-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062736207L00000X
WI42696207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34148800Medicaid
WINEMERRANOtherMERCYCARE INSURANCE
IL036062736 1Medicaid
WI24148800Medicaid
WI34148800Medicaid
WI034754176Medicare PIN
WINEMERRANOtherMERCYCARE INSURANCE