Healthcare Provider Details

I. General information

NPI: 1518913052
Provider Name (Legal Business Name): JAMES T NIEMEYER DO SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E LINCOLN HWY
NEW LENOX IL
60451-1911
US

IV. Provider business mailing address

600 E LINCOLN HWY
NEW LENOX IL
60451-1911
US

V. Phone/Fax

Practice location:
  • Phone: 815-485-5388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES T NIEMEYER
Title or Position: OWNER / PHYSICIAN
Credential: DO
Phone: 815-485-5388