Provider Demographics
NPI:1003241928
Name:THIAM, BABA
Entity Type:Individual
Prefix:
First Name:BABA
Middle Name:
Last Name:THIAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6642 LAKESIDE DR APT 302G
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7738
Mailing Address - Country:US
Mailing Address - Phone:513-546-1059
Mailing Address - Fax:
Practice Address - Street 1:6642 LAKESIDE DR
Practice Address - Street 2:302 G
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-7680
Practice Address - Country:US
Practice Address - Phone:513-546-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151658164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse