Provider Demographics
NPI:1760646699
Name:THIELEN, SREYOSHI (MD)
Entity type:Individual
Prefix:
First Name:SREYOSHI
Middle Name:
Last Name:THIELEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SREYOSHI
Other - Middle Name:
Other - Last Name:THIELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:605-328-6512
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-4973
Practice Address - Fax:605-328-1295
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52767207R00000X
SD8849208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine