Individual
TINA-MARIE THIEBAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4803 WARD RD, WHEAT RIDGE, CO 80033-1902
(303) 743-5855
Mailing address
13272 COLUMBINE CT, THORNTON, CO 80241-2072
(303) 280-2496
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
98117
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006717
KAISER-COMMERCIAL NUMBER
—
Enumeration date
02/16/2007
Last updated
07/08/2007
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