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NPI Code Detail

MEDICARE: DR. TIMOTHY A BURRELL MD

MEDICARE: DR. TIMOTHY A BURRELL 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
1207Q00000XFamily Medicine Physician01042017AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101042017AOTHERININDIANA LICENSE

General Provider Information

NPI Number : 1538116850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY A BURRELL MD
Provider Business Mailing Address
First Line : 2013 S RENWICK BLVD
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47401-7167
Country : US
Telephone Number : 812-320-4183
Fax Number : 812-347-4821
Provider Business Practice Location Address
First Line : 1001 N MADISON AVE
Second Line :
City : GREENWOOD
State : IN
Zip : 46142-4135
Country : US
Telephone Number : 317-888-3508
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 08/24/2024

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Directions to “ DR. TIMOTHY A BURRELL MD” Practice Location

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