Provider Demographics
NPI:1881892487
Name:NIEWALD, AMBER ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ELIZABETH
Last Name:NIEWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 RENNER RD # PODA
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9414
Mailing Address - Country:US
Mailing Address - Phone:913-588-8465
Mailing Address - Fax:816-271-7986
Practice Address - Street 1:7405 RENNER RD # PODA
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9414
Practice Address - Country:US
Practice Address - Phone:913-588-8465
Practice Address - Fax:816-271-7986
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013856207R00000X, 208M00000X
KS04-34370207R00000X
KS9406861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200654850AMedicaid
MO1881892487Medicaid
MOP01095186OtherRR MEDICARE
MO701000147Medicare PIN