Individual
MARK R. THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
595 W LAKE MEAD PKWY, HENDERSON, NV 89015-7015
(702) 565-1007
(702) 565-0836
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20364
NV
207Q00000X
Family Medicine Physician
ME104257
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001662200
—
FL
05
—
1467593715
—
NV
01
—
20364
STATE LICENSE
NV
Enumeration date
02/09/2007
Last updated
10/20/2022
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