Individual
THOMAS THILO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W IRONWOOD DR, SUITE 304, COEUR D ALENE, ID 83814-2656
(208) 667-1588
(208) 667-3788
Mailing address
700 W IRONWOOD DR, SUITE 304, COEUR D ALENE, ID 83814-2656
(208) 667-1588
(208) 667-3788
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-4920
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002592200
—
ID
01
—
020013147
RR MEDICARE
ID
05
—
1014299
—
WA
01
—
49205
BC ID
ID
Enumeration date
07/07/2006
Last updated
03/28/2008
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