Provider Demographics
NPI:1063551588
Name:THIEKEN, MICHAEL T (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:THIEKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1381
Mailing Address - Country:US
Mailing Address - Phone:317-802-2000
Mailing Address - Fax:317-802-2170
Practice Address - Street 1:10995 ALLISONVILLE RD
Practice Address - Street 2:#102
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2617
Practice Address - Country:US
Practice Address - Phone:317-915-8110
Practice Address - Fax:317-915-8120
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058064A207X00000X
IN01058064207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200915830Medicaid
IN037170L7Medicare PIN