Provider Demographics
NPI:1063189421
Name:MYRIAM B THIELE MD PLLC
Entity type:Organization
Organization Name:MYRIAM B THIELE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:THIELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-413-3532
Mailing Address - Street 1:5517 LOUETTA RD STE D
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5517 LOUETTA RD STE D
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7877
Practice Address - Country:US
Practice Address - Phone:346-413-3532
Practice Address - Fax:281-297-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty