Provider Demographics
NPI:1497641716
Name:THIESFELD, CONNOR RANDALL
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:RANDALL
Last Name:THIESFELD
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 1:2221 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7132
Mailing Address - Country:US
Mailing Address - Phone:419-251-1313
Mailing Address - Fax:
Practice Address - Street 1:2221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-7132
Practice Address - Country:US
Practice Address - Phone:419-251-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program