MEDICARE: DR. CRAIG H THAME M.D.

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	2085R0202X	Diagnostic Radiology Physician	25MA06149100	NJ
2	2085R0202X	Diagnostic Radiology Physician	101490	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149MP	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790760734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG H THAME M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1547
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-1547
Country	:	US
Telephone Number	:	877-440-0482
Fax Number	:	317-705-5060

Provider Business Practice Location Address
First Line	:	5352 LINTON BLVD
Second Line	:	ATTN: RADIOLOGY DEPT
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6514
Country	:	US
Telephone Number	:	561-498-4440
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	04/27/2012

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