Individual
MICAH PAUL NIERMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101
(651) 291-2848
(651) 602-6885
Mailing address
200 UNIVERSITY AVE E, SAINT PAUL, MN 55101-2507
(651) 291-2848
(651) 602-6885
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
17822
MN
208000000X
Pediatrics Physician
17822
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H400537804
MEDICARE PTAN
MN
Enumeration date
02/19/2007
Last updated
07/18/2019
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