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General NPI Number Information
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NPI Number | 1639213994
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Entity Type | Individual
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Provider Name | MICAH PAUL NIERMANN MD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 200 UNIVERSITY AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55101
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Country | US
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Telephone | 651-291-2848
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Fax | 651-602-6885
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Provider Business Mailing Address
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Address Line | 200 UNIVERSITY AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55101-2507
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Country | US
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Telephone | 651-291-2848
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Fax | 651-602-6885
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 17822
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 17822
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License Number State | MN
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