Provider Demographics
NPI:1922080308
Name:THIBODEAUX, LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:THIBODEAUX
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 1:11155 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1817
Mailing Address - Country:US
Mailing Address - Phone:513-385-1919
Mailing Address - Fax:513-385-6208
Practice Address - Street 1:11155 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-1817
Practice Address - Country:US
Practice Address - Phone:513-385-1919
Practice Address - Fax:513-385-6208
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063926208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0943242Medicaid
OH310837421SAOtherEMERALD HEALTH
OH000000007820OtherANTHEM
OH100328970AMedicaid
OH64958879Medicaid
OH14096OtherNATIONWIDE
OH310837421027Medicaid
OH1701181OtherUNITED HEALTHCARE
OH9246433001OtherCIGNA
OH0972646OtherAETNA
OH310837421OtherWAUSAU
020033575Medicare PIN
OH0943242Medicaid
OH64958879Medicaid
OH310837421027Medicaid
OH0753719Medicare PIN