Provider Demographics
NPI:1992754279
Name:NIEMI, NEIL A (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:A
Last Name:NIEMI
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 1:150 MOREY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1646
Mailing Address - Country:US
Mailing Address - Phone:937-644-1244
Mailing Address - Fax:937-642-7535
Practice Address - Street 1:150 MOREY DRIVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-644-1244
Practice Address - Fax:937-642-7535
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084849174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2652759Medicaid
OHNI4183401Medicare PIN
OHI53331Medicare UPIN