Healthcare Provider Details

I. General information

NPI: 1003131798
Provider Name (Legal Business Name): NICHOLAS NIEMIEC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY HEALTH LORAIN HOSPITAL 3700 KOLBE ROAD
LORAIN OH
44053
US

IV. Provider business mailing address

860 E BROAD ST STE 1
ELYRIA OH
44035-6542
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-8515
  • Fax:
Mailing address:
  • Phone: 440-323-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036131378
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34.011138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: