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NPI Code Detail

MEDICARE: DR. PETER D NIERMAN M.D.

MEDICARE: DR. PETER D NIERMAN M.D.
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
12084P0800XPsychiatry PhysicianG168746CA
22084P0804XChild & Adolescent Psychiatry PhysicianG168746CA

General Provider Information

NPI Number : 1801994769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER D NIERMAN M.D.
Provider Business Mailing Address
First Line : 1450 W LONG LAKE RD STE 340
Second Line :
City : TROY
State : MI
Zip : 48098-6330
Country : US
Telephone Number : 248-905-5091
Fax Number : 248-905-5096
Provider Business Practice Location Address
First Line : 200 FREEDOM LN
Second Line :
City : ALISO VIEJO
State : CA
Zip : 92656-5876
Country : US
Telephone Number : 949-900-8600
Fax Number : 949-221-3590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 03/21/2024

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