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General NPI Number Information
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NPI Number | 1487921920
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Entity Type | Organization
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Legal Business Name | WHOLE HEALTH MEDICAL GROUP OF OHIO PROF CORP
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 11530 NORTHLAKE DR
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City | CINCINNATI
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State | OH
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Zip | 45249-1642
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Country | US
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Telephone | 513-530-4104
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Fax | 513-748-3685
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Provider Business Mailing Address
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Address Line | 16906 COLLECTION CENTER DR
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City | CHICAGO
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State | IL
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Zip | 60693-0169
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Country | US
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Telephone | 877-865-9013
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Fax | 513-748-3685
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Authorized Official
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Title or Position | OWNER
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Name | JAMES THIEL
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Credential | M.D.
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Telephone | 615-468-6548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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