Basic Information
| Provider Information | |||||||||
| NPI: | 1669554176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THIES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 SHEIDLEY AVE | ||||||||
| Address2: | |||||||||
| City: | BONNER SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660129514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133227222 | ||||||||
| FaxNumber: | 9133227284 | ||||||||
| Practice Location | |||||||||
| Address1: | 913 SHEIDLEY AVE | ||||||||
| Address2: | |||||||||
| City: | BONNER SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660129514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133227222 | ||||||||
| FaxNumber: | 9133227284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2002008186 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0432505 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.