Provider Demographics
NPI:1659474625
Name:THIELEN, LOUISE A (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:A
Last Name:THIELEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1475 PINE GROVE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8803
Mailing Address - Country:US
Mailing Address - Phone:970-879-0203
Mailing Address - Fax:970-879-1389
Practice Address - Street 1:1475 PINE GROVE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8803
Practice Address - Country:US
Practice Address - Phone:970-879-0203
Practice Address - Fax:970-879-1389
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01310523Medicaid
CO370006298OtherRAILROAD MEDICARE
CO01310523Medicaid
CO0390360001Medicare NSC
COE96143Medicare UPIN