Provider Demographics
NPI:1992764096
Name:NIEHAUS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NIEHAUS
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:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-768-4350
Mailing Address - Fax:319-768-4355
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:STE 202
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-768-4350
Practice Address - Fax:319-768-4355
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23646208600000X
IA21014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0085811Medicaid
IAC01404OtherRR MED
IA1023564Medicaid
IA70237OtherBLUE SHIELD
020013500OtherRRMC
IA19927674096Medicaid
IAP00424584OtherRR MED
IAP00424584OtherRR MED
IA1023564Medicaid
IA70237OtherBLUE SHIELD
IA19927674096Medicaid