MEDICARE: TIMOTHY R WHITE MD

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	207L00000X	Anesthesiology Physician	036103106	IL

General Provider Information

NPI Number	:	1295721264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R WHITE MD

Provider Business Mailing Address
First Line	:	701 WINTHROP AVE
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-1405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 WINTHROP AVE
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139
Country	:	US
Telephone Number	:	630-545-5980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	03/19/2021

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