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General NPI Number Information
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NPI Number | 1033182555
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Entity Type | Individual
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Provider Name | MARY L. THIESSEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 4000 CAMBRIDGE ST
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City | KANSAS CITY
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State | KS
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Zip | 66160-3220
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Country | US
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Telephone | 913-588-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 78009
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City | SAINT LOUIS
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State | MO
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Zip | 63178-8009
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Country | US
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Telephone | 866-898-7142
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Fax | 616-975-9824
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34029
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2006014613
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License Number State | MO
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