Provider Demographics
NPI:1447237102
Name:NIEMI, WILLARD JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:JOHN
Last Name:NIEMI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:984-215-4111
Mailing Address - Fax:
Practice Address - Street 1:1505 SW CARY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-303-6890
Practice Address - Fax:919-460-0226
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC394213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0800FOtherBCBS
NC5452478OtherAETNA
NC6901556Medicaid
NC1094498OtherCIGNA
NC0800FOtherBCBS
NC5452478OtherAETNA