MEDICARE: DR. TIMOTHY VALE VOTAPKA M.D.

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	208600000X	Surgery Physician	036076786	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	55112-20	WI
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036076786	IL

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
2	01618941	OTHER	IL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598750200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY VALE VOTAPKA M.D.

Provider Business Mailing Address
First Line	:	9500 BORMET DR STE 204
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8399
Country	:	US
Telephone Number	:	708-346-4044
Fax Number	:	708-346-3287

Provider Business Practice Location Address
First Line	:	27750 W HIGHWAY 22
Second Line	:	SUITE 100
City	:	BARRINGTON
State	:	IL
Zip	:	60010-2379
Country	:	US
Telephone Number	:	847-816-3000
Fax Number	:	877-676-1549

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	12/17/2021

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