Provider Demographics
NPI:1932187804
Name:THIEME, RITA E (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:E
Last Name:THIEME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 S PERRY ST
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2668
Mailing Address - Country:US
Mailing Address - Phone:303-688-2228
Mailing Address - Fax:303-663-0640
Practice Address - Street 1:1001 S PERRY ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2668
Practice Address - Country:US
Practice Address - Phone:303-688-2228
Practice Address - Fax:303-663-0640
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO316852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01316850Medicaid
CO01316850Medicaid