MEDICARE: DR. DEVON JOSEPH NIEWOHNER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	TR-167	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1083289474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVON JOSEPH NIEWOHNER DPM

Provider Business Mailing Address
First Line	:	451 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103
Country	:	US
Telephone Number	:	336-716-2011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	08/19/2022

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