Healthcare Provider Details

I. General information

NPI: 1740232040
Provider Name (Legal Business Name): JOHN D NIEMELA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870W US HIGHWAY 2
MANISTIQUE MI
49854-8992
US

IV. Provider business mailing address

1015 N 3RD ST STE 6
MARQUETTE MI
49855-3500
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-2153
  • Fax: 906-341-1878
Mailing address:
  • Phone: 906-225-0181
  • Fax: 906-225-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002208
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number5901002008
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberJN002208
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: