MEDICARE: DR. CATHY NIEMAN MD

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	207R00000X	Internal Medicine Physician	20253	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100254520A	OTHER	OK	SOONERCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578556171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHY NIEMAN MD

Provider Business Mailing Address
First Line	:	821 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-4646
Fax Number	:	405-372-4685

Provider Business Practice Location Address
First Line	:	821 S WALNUT ST
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-4226
Country	:	US
Telephone Number	:	405-372-4646
Fax Number	:	405-372-4685

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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