Provider Demographics
NPI:1740232040
Name:NIEMELA, JOHN D (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:NIEMELA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N 3RD ST
Mailing Address - Street 2:STE 6
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3500
Mailing Address - Country:US
Mailing Address - Phone:906-225-0181
Mailing Address - Fax:906-225-0340
Practice Address - Street 1:7870W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-8992
Practice Address - Country:US
Practice Address - Phone:906-341-2153
Practice Address - Fax:906-341-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002208213E00000X
MI5901002008335E00000X
MIJN002208213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No335E00000XSuppliersProsthetic/Orthotic Supplier
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5901002208OtherLICENSE
MI134882948Medicaid
MIP00314266OtherRAILROAD MEDICARE
MI4855201230OtherBCBS
MI4882948OtherUPPER PENINSULA HLTH PLAN
MI213E00000XOtherTAXONOMY
MI510E210880OtherBCBSM ORTHOTIST
MI5790160001OtherADMINSTAR FEDERAL DME
MI611477200OtherUS DEPARTMENT OF LABOR
MI4855201230OtherBCBS
MI5790160001Medicare NSC
MI134882948Medicaid