Provider Demographics
NPI:1790753036
Name:NIEMI, TIMOTHY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:NIEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2287 STATE ROUTE 305
Mailing Address - Street 2:P. O. BOX 542
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9304
Mailing Address - Country:US
Mailing Address - Phone:330-841-3004
Mailing Address - Fax:330-841-3001
Practice Address - Street 1:2662 ELM RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-841-3004
Practice Address - Fax:330-841-3001
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053422207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine