Provider Demographics
NPI:1134212004
Name:WILLIAM J NIEMES MD INC
Entity type:Organization
Organization Name:WILLIAM J NIEMES MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-671-0799
Mailing Address - Street 1:422 RAY NORRISH DR # 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1520
Mailing Address - Country:US
Mailing Address - Phone:513-671-0799
Mailing Address - Fax:513-671-0845
Practice Address - Street 1:422 RAY NORRISH DR # 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1520
Practice Address - Country:US
Practice Address - Phone:513-671-0799
Practice Address - Fax:513-671-0845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF5846OtherRAILROAD MEDICARE
IN100256520AMedicaid
643419OtherAETNA
928184OtherAETNA
000000008215OtherANTHEM BCBS
000000008215OtherANTHEM BCBS
IN100256520AMedicaid
000000008215OtherANTHEM BCBS
928184OtherAETNA