Healthcare Provider Details

I. General information

NPI: 1417932526
Provider Name (Legal Business Name): DAVID G THOELE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-6465
  • Fax: 847-723-2251
Mailing address:
  • Phone: 847-723-6465
  • Fax: 847-723-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: