Healthcare Provider Details

I. General information

NPI: 1265549760
Provider Name (Legal Business Name): JENNIFER L THIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 MONTGOMERY RD STE 504
CINCINNATI OH
45242-4400
US

IV. Provider business mailing address

11595 N MERIDIAN ST STE 375
CARMEL IN
46032-3950
US

V. Phone/Fax

Practice location:
  • Phone: 513-922-0009
  • Fax: 513-931-2481
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35042512T
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35042512T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: