MEDICARE: EMILY NIEMI

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	363A00000X	Physician Assistant	5601011420	MI

General Provider Information

NPI Number	:	1386395895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NIEMI

Provider Business Mailing Address
First Line	:	903 E SUNNYBROOK DR
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-2791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2176 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2405
Country	:	US
Telephone Number	:	313-768-3290
Fax Number	:	877-409-3290

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

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	03/05/2026

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Directions to “ EMILY NIEMI ” Practice Location

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