Provider Demographics
NPI:1962407288
Name:THIEMKEY, WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:THIEMKEY
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 1:44 HUNTING LODGE DR
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-9799
Mailing Address - Country:US
Mailing Address - Phone:828-669-4485
Mailing Address - Fax:
Practice Address - Street 1:NAPLES RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732
Practice Address - Country:US
Practice Address - Phone:828-681-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01802207P00000X
MIWT007666208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903338Medicaid
MI1373910Medicaid
P00418628OtherRAILROAD MEDICARE
MI1373910Medicaid
NC2403005Medicare PIN
MI0B96007Medicare ID - Type Unspecified
NC2403005BMedicare PIN