Provider Demographics
NPI:1093838922
Name:THIEL, JAMES ALFRED (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALFRED
Last Name:THIEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 S GREENVILLE WEST DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3514
Practice Address - Country:US
Practice Address - Phone:616-754-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016857207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2711836OtherHIGHMARK BLUE SHIELD
MD055221400Medicaid
PA102719503Medicaid
PA1609750OtherGATEWAY
PA418502OtherUPMC
PA418502OtherUPMC
PA102719503Medicaid
PA2711836OtherHIGHMARK BLUE SHIELD
PA30151206OtherAMERIHEALTH CARITAS PA - WMG - WOY