Provider Demographics
NPI:1972784668
Name:THEISEN, CALANDRA D (DPM)
Entity type:Individual
Prefix:
First Name:CALANDRA
Middle Name:D
Last Name:THEISEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 39TH AVE NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4379
Mailing Address - Country:US
Mailing Address - Phone:612-788-7274
Mailing Address - Fax:612-788-3408
Practice Address - Street 1:2600 39TH AVE NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4379
Practice Address - Country:US
Practice Address - Phone:612-788-7274
Practice Address - Fax:612-788-3408
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN731213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist