Provider Demographics
NPI:1417505983
Name:THIEL, ALEXANDRA ELISABETH (PA-C, MMSC)
Entity Type:Individual
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First Name:ALEXANDRA
Middle Name:ELISABETH
Last Name:THIEL
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Gender:F
Credentials:PA-C, MMSC
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Mailing Address - Street 1:7978 GARFIELD AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1420 BUSSE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-5324
Practice Address - Country:US
Practice Address - Phone:847-653-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-02-09
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant