Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 2016014432 | MO |
N | 2080P0204X | Pediatric Emergency Doctor | 04-42038 | KS |
NPI | 1043471543 |
---|---|
Provider Name | Andrew Thill |
First Address | Kansas City, MO 64108-4619 |
Second Address | Kansas City, MO 64108-4619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 13/01/2022 |