Healthcare Provider Details

I. General information

NPI: 1215953153
Provider Name (Legal Business Name): MICHAEL NIEHANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 WAYZATA BLVD
MINNEAPOLIS MN
55405-2131
US

IV. Provider business mailing address

2809 WAYZATA BLVD
MINNEAPOLIS MN
55405-2131
US

V. Phone/Fax

Practice location:
  • Phone: 612-377-9190
  • Fax: 612-374-4498
Mailing address:
  • Phone: 612-377-9190
  • Fax: 612-374-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27774
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number27774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: