Healthcare Provider Details

I. General information

NPI: 1265466205
Provider Name (Legal Business Name): WILLIAM FRANK THISTLETHWAITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8146 HAMILTON AVE
CINCINNATI OH
45231-2324
US

IV. Provider business mailing address

415 LOVELAND MIAMIVILLE RD
LOVELAND OH
45140-6938
US

V. Phone/Fax

Practice location:
  • Phone: 513-588-3623
  • Fax: 513-728-4064
Mailing address:
  • Phone: 513-340-4278
  • Fax: 513-728-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: