Basic Information
| Provider Information | |||||||||
| NPI: | 1245506229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIEMS | ||||||||
| FirstName: | GRADY | ||||||||
| MiddleName: | EARL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662044004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136762214 | ||||||||
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| Address1: | 9100 W 74TH ST | ||||||||
| Address2: | |||||||||
| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136762214 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2012 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2014004835 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 04-37894 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.