Individual
DALE E. THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
7229 CLEARVISTA DR, INDIANAPOLIS, IN 46256-1698
(317) 621-4341
(317) 621-4366
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
200110234A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000538641
ANTHEM
IN
05
—
100134220
—
IN
Enumeration date
02/03/2006
Last updated
11/27/2023
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