Provider Demographics
NPI:1821186768
Name:THELEN, GREGORY LLOYD THELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LLOYD THELEN
Last Name:THELEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18837 IROQUOIS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4455
Mailing Address - Country:US
Mailing Address - Phone:612-467-1921
Mailing Address - Fax:
Practice Address - Street 1:18837 IROQUOIS WAY
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4455
Practice Address - Country:US
Practice Address - Phone:612-467-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN446172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry