Individual
MARK A THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1223 WILLOW CREEK RD, PRESCOTT, AZ 86301-1427
(928) 777-9950
(928) 777-9975
Mailing address
1223 WILLOW CREEK RD, PRESCOTT, AZ 86301-1427
(928) 777-9950
(928) 777-9975
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4659
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291957500
—
FL
05
—
782816
—
AZ
Enumeration date
05/27/2005
Last updated
03/29/2017
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