Healthcare Provider Details

I. General information

NPI: 1114967627
Provider Name (Legal Business Name): JOSHUA JOE NIEMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR SUITE 204
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2609 GLENN HENDREN DR
LIBERTY MO
64068-3313
US

V. Phone/Fax

Practice location:
  • Phone: 816-781-6066
  • Fax: 816-792-5130
Mailing address:
  • Phone: 816-407-4555
  • Fax: 816-407-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2004011007
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: