Individual
MICHELLE L THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6405 FRANCE AVE S # SW200, EDINA, MN 55435-2163
(952) 915-5482
Mailing address
845 RAMSEY AVE, CARVER, MN 55315-4515
(952) 679-4280
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9833
MN
Other
Enumeration date
11/30/2005
Last updated
10/25/2007
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