MEDICARE: JOHN M THIEL DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	JT007090	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2052300374	OTHER	MI	BLUE CROSS BLUE SHIELD
2	200000000915	OTHER	MI	PHP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538188685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN M THIEL DO

Provider Business Mailing Address
First Line	:	321 E HARRIS ST
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1629
Country	:	US
Telephone Number	:	517-543-1050
Fax Number	:	517-541-5870

Provider Business Practice Location Address
First Line	:	123 LANSING ST
Second Line	:	SUITE 2
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1696
Country	:	US
Telephone Number	:	517-543-7976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/06/2012

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