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General NPI Number Information
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NPI Number | 1740232040
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Entity Type | Individual
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Provider Name | JOHN D NIEMELA DPM
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 7870W US HIGHWAY 2
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City | MANISTIQUE
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State | MI
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Zip | 49854-8992
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Country | US
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Telephone | 906-341-2153
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Fax | 906-341-1878
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Provider Business Mailing Address
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Address Line | 1015 N 3RD ST 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 |
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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 | 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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 5901002008
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | JN002208
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License Number State | MI
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