Healthcare Provider Details

I. General information

NPI: 1801141726
Provider Name (Legal Business Name): TIMOTHY VOLK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 W RAND RD
MT PROSPECT IL
60056-1151
US

IV. Provider business mailing address

199 W RAND RD
MT PROSPECT IL
60056-1151
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-5400
  • Fax: 847-618-3709
Mailing address:
  • Phone: 847-618-5400
  • Fax: 847-618-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036138600
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036138600
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR9586
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: