MEDICARE: DAVID THEIS, D.O., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	OS017698	PA

General Provider Information

NPI Number	:	1740718998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID THEIS, D.O., P.C.

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1056
Country	:	US
Telephone Number	:	719-475-9613
Fax Number	:	719-475-9539

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1056
Country	:	US
Telephone Number	:	719-475-9613
Fax Number	:	719-475-9539

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID THEIS
Credential	:	DO
Telephone Number	:	740-317-9272

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/01/2017

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