Provider Demographics
NPI:1386512804
Name:THIEMAN, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:THIEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CREST DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99712-1632
Mailing Address - Country:US
Mailing Address - Phone:501-628-1324
Mailing Address - Fax:
Practice Address - Street 1:252 CREST DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99712-1632
Practice Address - Country:US
Practice Address - Phone:501-628-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty