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1740232040

NPI Code Detail

MEDICARE: JOHN D NIEMELA DPM

MEDICARE: JOHN D NIEMELA 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	213E00000X	Podiatrist	5901002208	MI
2	335E00000X	Prosthetic/Orthotic Supplier	5901002008	MI
3	213ES0103X	Foot & Ankle Surgery Podiatrist	JN002208	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00314266	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5901002208	OTHER	MI	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4855201230	OTHER	MI	BCBS
5	4882948	OTHER	MI	UPPER PENINSULA HLTH PLAN
6	213E00000X	OTHER	MI	TAXONOMY
7	510E210880	OTHER	MI	BCBSM ORTHOTIST
8	5790160001	OTHER	MI	ADMINSTAR FEDERAL DME
9	611477200	OTHER	MI	US DEPARTMENT OF LABOR

General Provider Information

NPI Number	:	1740232040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D NIEMELA DPM

Provider Business Mailing Address
First Line	:	1015 N 3RD ST
Second Line	:	STE 6
City	:	MARQUETTE
State	:	MI
Zip	:	49855-3500
Country	:	US
Telephone Number	:	906-225-0181
Fax Number	:	906-225-0340

Provider Business Practice Location Address
First Line	:	7870W US HIGHWAY 2
Second Line	:
City	:	MANISTIQUE
State	:	MI
Zip	:	49854-8992
Country	:	US
Telephone Number	:	906-341-2153
Fax Number	:	906-341-1878

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	04/25/2017

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Directions to “ JOHN D NIEMELA DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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