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KAREN CHRISTIANE THEILADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
120 CYPRESS EDGE DR, SUITE 203, PALM COAST, FL 32164-8453
(386) 586-4410
(386) 445-3398
Mailing address
120 CYPRESS EDGE DR, SUITE 203, PALM COAST, FL 32164-8453
(386) 586-4410
(386) 445-3398

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME106807
FL
207RI0011X
Interventional Cardiology Physician
ME106807
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003120001
FL
01
14AA4
BCBS
FL
01
P01170719
RAILROAD
FL
Enumeration date
02/09/2007
Last updated
09/30/2013
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