Individual
DR. RANDY T THEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
451 E BROOKLYN ST, CHILTON, WI 53014-1595
(920) 849-9375
Mailing address
451 E BROOKLYN ST, CHILTON, WI 53014-1595
(920) 849-9375
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21872
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30278000
—
WI
Enumeration date
10/20/2005
Last updated
07/08/2007
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