Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-095330 | IL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-095330 | IL |
NPI | 1124073838 |
---|---|
Provider Name | Tomas Nemickas |
First Address | Des Plaines, IL 60016-2359 |
Second Address | Gurnee, IL 60031-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 30/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-095330 | (05) | IL |
G94551 | (02) | IL |