Individual
MR. MARK J THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
(320) 257-5523
Mailing address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
(320) 259-4100
(320) 257-5523
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
32514
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243877100
—
MN
Enumeration date
07/11/2006
Last updated
02/24/2021
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