Provider Demographics
NPI:1811093958
Name:THIEL, BRENT G (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:G
Last Name:THIEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3726 BROADWAY
Mailing Address - Street 2:STE 201
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3788
Mailing Address - Country:US
Mailing Address - Phone:425-317-9119
Mailing Address - Fax:425-317-9118
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:STE 201
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3788
Practice Address - Country:US
Practice Address - Phone:425-317-9119
Practice Address - Fax:425-317-9118
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-07-26
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Provider Licenses
StateLicense IDTaxonomies
WA42333207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1019547Medicaid
H19384Medicare UPIN
WAAB38225Medicare PIN