MEDICARE: DR. DOUGLAS ALAN NEMECEK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	36189	MN

General Provider Information

NPI Number	:	1518020288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ALAN NEMECEK MD

Provider Business Mailing Address
First Line	:	11095 VIKING DR
Second Line	:	SUITE 350
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7223
Country	:	US
Telephone Number	:	952-996-3295
Fax Number	:	952-996-2599

Provider Business Practice Location Address
First Line	:	11095 VIKING DR
Second Line	:	SUITE 350
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7223
Country	:	US
Telephone Number	:	952-996-3295
Fax Number	:	952-996-2599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	07/08/2007

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