Healthcare Provider Details

I. General information

NPI: 1710037122
Provider Name (Legal Business Name): DOROTHY K NEMEC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 TAMIAMI TRL
PORT CHARLOTTE FL
33952-8002
US

IV. Provider business mailing address

3221 TAMIAMI TRL
PORT CHARLOTTE FL
33952-8002
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-8720
  • Fax: 941-505-8747
Mailing address:
  • Phone: 941-505-8720
  • Fax: 941-505-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME79412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: