Provider Demographics
NPI:1083621155
Name:NIEMEYER, JOHN H (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:NIEMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WESTPORT PLZ
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3109
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:3015 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131
Practice Address - Country:US
Practice Address - Phone:314-996-5180
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4F792085R0202X
IL0361084532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
003013128OtherCARE
398022OtherHLT PART
431725842MIDOtherMERCY
6707OtherHCARE USA
008012444OtherMO CARE
101033OtherH LINK
1078154OtherMC MCAID
A12511OtherGATE WAY
300066988OtherRR CARE
003013128OtherMO CARE
008012444OtherCARE
1650514OtherPH PLAN
28081OtherBLUE CHOICE
2781OtherGHP
0090000352OtherIL BLUE
1390OtherMO BLUE
202282406OtherMO CAID
2781OtherGHP
101033OtherH LINK
300066988Medicare PIN