| Doctor Name: | DR. MARIO THELIARD |
| NPI Number: | 1669804720 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 020982 |
| Business Practice Address: | 3810 S Florida Ave Lakeland, FL - 338131105 |
| Business Phone Number: | 8638588000 |
| Business Fax Number: | |
| Mailing Address: | 4094 Lake Ned Village Cir, WINTER HAVEN |
| State: | FL |
| Postal Code: | 338842587 |
| Phone Number: | 5612154914 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2013 |
| NPI Last Update Date: | 02/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 020982 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |