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General NPI Number Information
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NPI Number | 1245384577
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Entity Type | Organization
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Legal Business Name | MID MICHIGAN OBSTETRICS & GYNECOLOGY PC
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3016 W WACKERLY ST
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City | MIDLAND
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State | MI
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Zip | 48640-6160
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Country | US
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Telephone | 989-631-6730
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Fax | 989-631-4968
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Provider Business Mailing Address
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Address Line | 3016 W WACKERLY ST
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City | MIDLAND
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State | MI
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Zip | 48640-6160
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Country | US
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Telephone | 989-631-6730
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Fax | 989-631-4968
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Authorized Official
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Title or Position | OWNER
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Name | DR. SCOTT ALLEN THIELE
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Credential | MD
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Telephone | 989-631-6730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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