| Kim Thiele, DO, PC | |
|
105 Trading Bay Dr Suite 105 Kenai AK 99611-7717 | |
| (907) 242-9000 | |
| Not Available |
| Full Name | Kim Thiele, DO, PC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 105 Trading Bay Dr, Kenai, Alaska |
| Authorized Official Name and Position | Kim E Thiele (EXECUTIVE OFFICER) |
| Authorized Official Contact | 9072429000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Thiele, DO, PC 105 Trading Bay Dr Suite 105 Kenai AK 99611-7717 Ph: (907) 242-9000 | Kim Thiele, DO, PC 105 Trading Bay Dr Suite 105 Kenai AK 99611-7717 Ph: (907) 242-9000 |
| NPI Number | 1972894418 |
|---|---|
| Provider Enumeration Date | 05/02/2011 |
| Last Update Date | 05/02/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972894418 | NPI | - | NPPES |
| MD41253 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 4125 (Alaska) | Primary |
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