Healthcare Provider Details

I. General information

NPI: 1588231617
Provider Name (Legal Business Name): MICHAEL NIEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44450 PINETREE DR
PLYMOUTH MI
48170-3869
US

IV. Provider business mailing address

5207 RED FOX RUN
ANN ARBOR MI
48105-9364
US

V. Phone/Fax

Practice location:
  • Phone: 734-738-0897
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801063416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: