Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 01032804 | IN |
N | 207P00000X | Emergency Physician | 36070247 | IL |
NPI | 1003843665 |
---|---|
Provider Name | Dr. Ted Robert Niemiec |
First Address | Munster, IN 46321-3566 |
Second Address | Munster, IN 46321-3566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 06/10/2020 |