Provider Demographics
NPI:1093766107
Name:NIETERS, JOHN LACARI (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LACARI
Last Name:NIETERS
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 1:2753 FOX POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3224
Mailing Address - Country:US
Mailing Address - Phone:812-376-9291
Mailing Address - Fax:812-378-8390
Practice Address - Street 1:2753 FOX POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3224
Practice Address - Country:US
Practice Address - Phone:812-376-9291
Practice Address - Fax:812-378-8390
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035527A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080018882OtherRR MEDICARE
003708OtherSIHO
000000086962OtherANTHEM
E24164Medicare UPIN