Individual
MR. MARK WALTER THIEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
3301 MERCY HEALTH BLVD STE 450, CINCINNATI, OH 45211-1106
(513) 347-9999
(513) 215-9397
Mailing address
3301 MERCY HEALTH BLVD STE 450, CINCINNATI, OH 45211-1106
(513) 347-9999
(513) 215-9397
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50-00-0882
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077577
—
OH
01
—
PA-P00919620
MEDICARE RR
OH
Enumeration date
10/25/2005
Last updated
08/19/2024
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