Organization
KIM THIELE, DO, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM E THIELE DO (EXECUTIVE OFFICER)
(907) 242-9000
Entity
Organization
Contact information
Practice address
105 TRADING BAY DR, SUITE 105, KENAI, AK 99611-7717
(907) 242-9000
Mailing address
105 TRADING BAY DR, SUITE 105, KENAI, AK 99611-7717
(907) 242-9000
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4125
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD41253
—
AK
Enumeration date
05/02/2011
Last updated
05/02/2011
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