Provider Demographics
NPI:1902801509
Name:THIIM, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:THIIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6278
Mailing Address - Country:US
Mailing Address - Phone:978-521-3270
Mailing Address - Fax:978-374-6495
Practice Address - Street 1:1 PARKWAY
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6278
Practice Address - Country:US
Practice Address - Phone:978-521-3270
Practice Address - Fax:978-374-6495
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79926207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3129136Medicaid
MA989724OtherNETWORK HEALTH
MA6831016OtherHEALTHSOURCE
NHF21237OtherANTHEM BLUE CROSS
MAF21237OtherHARVARD PILGRIM HEALTHCAR
NH30202213OtherNH MEDICAID
MAJ30761OtherBLUE CROSS BLUE SHIELD
MA0017426OtherNEIGHBORHOOD HEALTH PLAN
MA29-00989OtherEVERCARE
7976770OtherCIGNA
MA758217OtherTUFTS HEALTH CARE
MA3129136Medicaid
MA6831016OtherHEALTHSOURCE