Provider Demographics
NPI:1689730764
Name:THIEL, ELIZABETH LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEE
Last Name:THIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:LEE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:PALLIATIVE CARE/HOSPICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-4600
Mailing Address - Fax:414-805-6805
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:PALLIATIVE CARE/HOSPICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-4600
Practice Address - Fax:414-805-6805
Is Sole Proprietor?:No
Enumeration Date:2006-12-31
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48887-020208000000X
WI48887207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1689730764Medicaid
WI1689730764Medicaid
WI68086 2751Medicare PIN