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General NPI Number Information
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NPI Number | 1457536187
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Entity Type | Organization
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Legal Business Name | WILLIAM J THIEMAN MD PC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 1217 EAST ELIZABETH SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4040
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Country | US
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Telephone | 970-484-7245
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Fax | 970-484-1398
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Provider Business Mailing Address
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Address Line | 1217 EAST ELIZABETH SUITE 1
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City | FORT COLLINS
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State | CO
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Zip | 80524-4040
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Country | US
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Telephone | 970-484-7245
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Fax | 970-484-1398
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Authorized Official
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Title or Position | OFFICE MANAGER CORPORATE SECRETARY
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Name | MRS. EILEEN MORGAN THIEMAN
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Credential |
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Telephone | 970-484-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19190
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License Number State | CO
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