Individual
DR. KAY ELLEN THEYERL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 THEDA CLARK MEDICAL PLZ, SUITE 240, NEENAH, WI 54956-2721
(920) 725-2070
(920) 725-4549
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3200
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
46219-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34471300
—
WI
01
—
711290047
MEDICARE PTAN
WI
Enumeration date
08/02/2005
Last updated
06/25/2012
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