Healthcare Provider Details

I. General information

NPI: 1851363378
Provider Name (Legal Business Name): JOSEPH P NEMANICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 25TH AVE S SUITE 505
MINNEAPOLIS MN
55454-1513
US

IV. Provider business mailing address

701 25TH AVE S SUITE 505
MINNEAPOLIS MN
55454-1513
US

V. Phone/Fax

Practice location:
  • Phone: 612-455-2008
  • Fax: 612-455-2045
Mailing address:
  • Phone: 612-455-2008
  • Fax: 612-455-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number44778
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: