Healthcare Provider Details

I. General information

NPI: 1043290125
Provider Name (Legal Business Name): RIMAS J NEMICKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ILLINI DR
SILVIS IL
61282-1804
US

IV. Provider business mailing address

8420 W BRYN MAWR AVE STE 300
CHICAGO IL
60631-3436
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-4000
  • Fax:
Mailing address:
  • Phone: 773-355-5300
  • Fax: 773-714-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01078992A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.093412
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-32843
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: