MEDICARE: TIMOTHY A DELEHANTY 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	207V00000X	Obstetrics & Gynecology Physician	01028947A	IN
2	207V00000X	Obstetrics & Gynecology Physician	31793	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346236874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY A DELEHANTY MD

Provider Business Mailing Address
First Line	:	3501 IROQUOIS TRL
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-1013
Country	:	US
Telephone Number	:	219-879-4364
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 IROQUOIS TRL
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-1013
Country	:	US
Telephone Number	:	219-879-4374
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/23/2012

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