Provider Demographics
NPI:1881762060
Name:THIENEMAN, ANDREW CHRISTIAN JR (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:CHRISTIAN
Last Name:THIENEMAN
Suffix:JR
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:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-6638
Mailing Address - Fax:812-450-8109
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-6638
Practice Address - Fax:812-450-8109
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027883A207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64758162OtherKY MEDICAID
IN100086800Medicaid
IND95664Medicare UPIN
KY64758162OtherKY MEDICAID
IN100086800Medicaid
IN257900JJJMedicare PIN