Michelle L Theobald, PA-C

NPI #1912981341 in Edina, Minnesota

Provider Information

NPI Number: 1912981341
Entity Type: Individual
Name: Michelle L Theobald, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: PA-C
Enumeration Date: Nov 30, 2005
Last Updated: Oct 25, 2007

Practice Location

Address: 6405 FRANCE AVE S # SW200
City: Edina
State: Minnesota
ZIP Code: 55435-2163
Phone: (952) 915-5482

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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