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NPI Code Detail

MEDICARE: DR. CRAIG SMITH THIELE M.D.

MEDICARE: DR. CRAIG SMITH THIELE 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
1207R00000XInternal Medicine Physician35057696OH

General Provider Information

NPI Number : 1962710723
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG SMITH THIELE M.D.
Provider Business Mailing Address
First Line : 1946 S CLAYTON RD
Second Line :
City : NEW LEBANON
State : OH
Zip : 45345-9736
Country : US
Telephone Number : 937-687-1791
Fax Number :
Provider Business Practice Location Address
First Line : 230 N MAIN ST
Second Line :
City : DAYTON
State : OH
Zip : 45402-1263
Country : US
Telephone Number : 937-531-2132
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2010
Last Update Date : 09/15/2010

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