Provider Demographics
NPI:1689784811
Name:THIENHAUS, OLE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLE
Middle Name:
Last Name:THIENHAUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N. CAMPBELL AVE
Mailing Address - Street 2:70PC PSYCHIATRY DEPARTMENT
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724
Mailing Address - Country:US
Mailing Address - Phone:702-671-2355
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:1501 N. CAMPBELL AVE
Practice Address - Street 2:70PC PSYCHIATRY DEPARTMENT
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724
Practice Address - Country:US
Practice Address - Phone:520-626-6255
Practice Address - Fax:520-626-4070
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV76112084P0800X
AZ199202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016553Medicaid
NV002016553Medicaid
NVA15749Medicare UPIN