MEDICARE: CHAD MICHAEL THOEMKE PA

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1649258740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD MICHAEL THOEMKE PA

Provider Business Mailing Address
First Line	:	2080 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	910-787-3754
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CHILD ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5005
Country	:	US
Telephone Number	:	904-542-7365
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	09/11/2024

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