Provider Demographics
NPI:1750876629
Name:THIEMANN, MARCUS CHARLES (DO)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:CHARLES
Last Name:THIEMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S WOODWORTH LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8984
Mailing Address - Country:US
Mailing Address - Phone:907-861-6700
Mailing Address - Fax:907-861-6742
Practice Address - Street 1:2500 S WOODWORTH LOOP
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8984
Practice Address - Country:US
Practice Address - Phone:907-861-6700
Practice Address - Fax:907-861-6742
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018018693207R00000X
AK176399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine