Provider Demographics
NPI:1801164561
Name:IHLE, TED WILLIAM
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:WILLIAM
Last Name:IHLE
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 1:3833 HOLLYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7917
Mailing Address - Country:US
Mailing Address - Phone:513-967-8004
Mailing Address - Fax:
Practice Address - Street 1:3833 HOLLYBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-7917
Practice Address - Country:US
Practice Address - Phone:513-967-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.143133-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse