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General NPI Number Information
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NPI Number | 1114097474
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Entity Type | Organization
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Legal Business Name | JOHN NIEMELA
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 1015 N 3RD ST SUITE #6
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City | MARQUETTE
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State | MI
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Zip | 49855-3500
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Country | US
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Telephone | 906-225-0181
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Fax | 906-225-0340
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Provider Business Mailing Address
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Address Line | 1015 N 3RD STREET STE 6
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City | MARQUETTE
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State | MI
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Zip | 49855-3500
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Country | US
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Telephone | 906-225-0181
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Fax | 906-225-0340
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | JOHN D NIEMELA
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Credential | DPM
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Telephone | 906-225-0181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 5901002208
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901002208
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License Number State | MI
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