Provider Demographics
NPI:1568535938
Name:THIEME, PAUL O JR (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:O
Last Name:THIEME
Suffix:JR
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 1:1895 M 28 E
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9546
Mailing Address - Country:US
Mailing Address - Phone:906-249-4942
Mailing Address - Fax:
Practice Address - Street 1:420 W MAGNETIC STREET
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-228-9440
Practice Address - Fax:906-225-3772
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0102722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4565403Medicaid
MIN85060001Medicare ID - Type Unspecified
MI4565403Medicaid