Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35087440 | OH |
Y | 207X00000X | Orthopaedic Surgeon | 54425-20 | WI |
NPI | 1023050093 |
---|---|
Provider Name | Eric Thiel |
First Address | Wausau, WI 54401-2950 |
Second Address | Wausau, WI 54401-2950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 17/06/2021 |