Provider Demographics
NPI:1932157682
Name:NEMANICH, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:NEMANICH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4200 DAHLBERG DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4840
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:952-512-5651
Practice Address - Street 1:701 25TH AVE S
Practice Address - Street 2:SUITE 505
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1513
Practice Address - Country:US
Practice Address - Phone:612-455-2008
Practice Address - Fax:612-455-2045
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-08-15
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Provider Licenses
StateLicense IDTaxonomies
MN37192207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF84576Medicare UPIN