Healthcare Provider Details

I. General information

NPI: 1417696600
Provider Name (Legal Business Name): MICHAEL B. NEMSICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 10/09/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 HARLEM ROAD
LOVES PARK IL
61111-2701
US

IV. Provider business mailing address

2202 HARLEM ROAD
LOVES PARK IL
61111-2701
US

V. Phone/Fax

Practice location:
  • Phone: 815-877-4848
  • Fax: 815-654-5342
Mailing address:
  • Phone: 815-877-4848
  • Fax: 815-654-5342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.175202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: