Provider Demographics
NPI:1225486160
Name:THEISEN, ALEXANDRA NICOLE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:PO BOX 778912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-8912
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-2172
Practice Address - Fax:317-278-3031
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2025-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01082379A2080P0216X
MO2022019876208000000X, 2080P0216X
ARE-179532080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics