MEDICARE: MR. TIMOTHY O. WAHL 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	14753	NE

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	:	1932191517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY O. WAHL M.D.

Provider Business Mailing Address
First Line	:	7831 CHICAGO COURT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3654
Country	:	US
Telephone Number	:	402-561-2740
Fax Number	:	402-561-2738

Provider Business Practice Location Address
First Line	:	7831 CHICAGO COURT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3654
Country	:	US
Telephone Number	:	402-561-2740
Fax Number	:	402-561-2738

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/05/2014

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