Individual
DR. JILLIAN LEE THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-6450
(414) 805-6464
Mailing address
9200 W WISCONSIN AVE, DEPT OF EMERGENCY MEDICINE, MILWAUKEE, WI 53226-3522
(414) 805-6450
(414) 805-6464
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
125.057942
IL
207P00000X
Emergency Medicine Physician
Primary
64253
WI
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
64253
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750606968
—
WI
Enumeration date
03/30/2010
Last updated
11/07/2022
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