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General NPI Number Information
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NPI Number | 1386264018
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Entity Type | Individual
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Provider Name | CHAD THEBEAU ARRT (R.T.) (MR)
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Gender | Male
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 2142 N COVE BLVD
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City | TOLEDO
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State | OH
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Zip | 43606-3895
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Country | US
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Telephone | 419-450-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 6556 W BANCROFT ST
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City | TOLEDO
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State | OH
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Zip | 43615-3162
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Country | US
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Telephone | 419-450-5716
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Fax |
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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 | 207RM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Internal Medicine Physician
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License Number | 565856
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License Number State | OH
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