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1912981341
MICHELLE L THEOBALD
EDINA, MN
NPI
1912981341
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Former Name
MICHELLE L JOHNSON
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MN 9833)
Enumeration Date
2005-11-30
Last Update Date
2007-10-25
Business Address
-- MICHELLE L THEOBALD PA-C
6405 FRANCE AVE S # SW200
EDINA, MN 55435-2163
Phone number: 952-915-5482
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Mailing Address
-- MICHELLE L THEOBALD PA-C
845 RAMSEY AVE
CARVER, MN 55315-4515
Phone number: 952-679-4280
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