Healthcare Provider Details

I. General information

NPI: 1922080308
Provider Name (Legal Business Name): LOUIS THIBODEAUX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 KENWOOD RD
CINCINNATI OH
45242-1817
US

IV. Provider business mailing address

11155 KENWOOD RD
CINCINNATI OH
45242-1817
US

V. Phone/Fax

Practice location:
  • Phone: 513-385-1919
  • Fax: 513-385-6208
Mailing address:
  • Phone: 513-385-1919
  • Fax: 513-385-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35063926
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35063926
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: