Provider Demographics
NPI:1417417510
Name:THIEL, CEDRIC N (MD)
Entity type:Individual
Prefix:
First Name:CEDRIC
Middle Name:N
Last Name:THIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:740 SOUTH LIMESTONE E300E
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-257-5405
Mailing Address - Fax:859-323-5483
Practice Address - Street 1:740 SOUTH LIMESTONE C300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-257-5405
Practice Address - Fax:859-323-5483
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYR5220207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology