Provider Demographics
NPI:1659985679
Name:THIELEN, MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:THIELEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1608 TOWN CENTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3639
Mailing Address - Country:US
Mailing Address - Phone:954-349-2345
Mailing Address - Fax:954-641-1086
Practice Address - Street 1:1600 TOWN CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-5900
Practice Address - Fax:954-389-5751
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9113500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant