Provider Demographics
NPI:1043290125
Name:NEMICKAS, RIMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:RIMAS
Middle Name:J
Last Name:NEMICKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3436
Mailing Address - Country:US
Mailing Address - Phone:773-355-5300
Mailing Address - Fax:773-714-1353
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-281-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078992A207L00000X
IL036.093412207L00000X
IAMD-32843207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA190231Medicaid
IA190231Medicaid
IA48999Medicare ID - Type Unspecified