Individual
MARY L. THIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4000 CAMBRIDGE ST, KANSAS CITY, KS 66160-3220
(913) 588-6500
Mailing address
PO BOX 78009, SAINT LOUIS, MO 63178-8009
(866) 898-7142
(616) 975-9824
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2006014613
MO
207P00000X
Emergency Medicine Physician
34029
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226405
—
MO
05
—
2004140908
—
MO
05
—
200414090A
—
KS
05
—
200414090C
—
KS
05
—
200414090D
—
KS
01
—
37400018
BCBS
—
01
—
431832147A061
CHAMPUS
—
05
—
952855
—
AZ
01
—
P00393445
RAILROAD MEDICARE
—
Enumeration date
02/08/2006
Last updated
08/22/2022
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