Healthcare Provider Details

I. General information

NPI: 1598919904
Provider Name (Legal Business Name): JENNIFER THIE MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 CARVER WOODS DR SUITE 125
CINCINNATI OH
45242-5545
US

IV. Provider business mailing address

4430 CARVER WOODS DR SUITE 125
CINCINNATI OH
45242-5545
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-1430
  • Fax: 513-792-6849
Mailing address:
  • Phone: 513-794-1430
  • Fax: 513-792-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER L THIE
Title or Position: OWNER
Credential: MD
Phone: 513-794-1430