Provider Demographics
NPI:1841462421
Name:NIEMANN, SPENCER LUNA NUI (DPM)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LUNA NUI
Last Name:NIEMANN
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 1:1831 E QUEEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2019
Mailing Address - Country:US
Mailing Address - Phone:480-917-2300
Mailing Address - Fax:480-917-5400
Practice Address - Street 1:1831 E QUEEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2019
Practice Address - Country:US
Practice Address - Phone:480-917-2300
Practice Address - Fax:480-917-5400
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0672213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ326978Medicaid
AZ326978Medicaid