Provider Demographics
NPI:1053042515
Name:THIEME, ELLIOTT RYAN (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:RYAN
Last Name:THIEME
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N WASHINGTON AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1278
Mailing Address - Country:US
Mailing Address - Phone:616-485-6004
Mailing Address - Fax:
Practice Address - Street 1:29201 TELEGRAPH RD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7648
Practice Address - Country:US
Practice Address - Phone:248-569-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist