Healthcare Provider Details

I. General information

NPI: 1417921800
Provider Name (Legal Business Name): TOBY THIELGES PTMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 7TH ST
OAKES ND
58474-2024
US

IV. Provider business mailing address

7274 108TH AVE SE
LAMOURE ND
58458-9409
US

V. Phone/Fax

Practice location:
  • Phone: 701-742-3267
  • Fax: 701-742-3201
Mailing address:
  • Phone: 701-830-9514
  • Fax: 701-883-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1096
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: