Theobald, Jillian Lee

Theobald, Jillian Lee is an individual health care provider with primary practice located at 9200 W Wisconsin Ave , Milwaukee WI 53226-3522. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Medical Toxicology. Allopathic & Osteopathic Physicians / Emergency Medicine is her primary health care specialty. Theobald, Jillian Lee can be contacted via phone (414) 805-6450.

Contact Information

Primary practice address
9200 W Wisconsin Ave Milwaukee WI 53226-3522
Phone: (414) 805-6450
Fax: (414) 805-6464
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 125.057942 Illinois
Allopathic & Osteopathic Physicians / Medical Toxicology 207PT0002X 64253 Wisconsin
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 64253 Wisconsin

Profile Details

NPI number 1750606968
LBN Legal business name Theobald, Jillian Lee
Credentials MD PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 30th, 2010
Last updated Nov 7th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750606968 NPPES
Wisconsin MEDICAID 1750606968

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