Individual
DR. KIM EDWARD THIELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
36901 MALLARD RD, KENAI, AK 99611-6434
(907) 283-5000
(907) 283-5013
Mailing address
36901 MALLARD RD, KENAI, AK 99611-6434
(907) 283-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MEDO4125
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013951
—
AK
Enumeration date
01/12/2007
Last updated
11/20/2019
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