Healthcare Provider Details

I. General information

NPI: 1316160328
Provider Name (Legal Business Name): TIMOTHY W NUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/17/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S MAIN ST
GOSHEN IN
46526-5236
US

IV. Provider business mailing address

PO BOX 834
GOSHEN IN
46527-0834
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-7600
  • Fax: 574-533-7666
Mailing address:
  • Phone: 574-364-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01066665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: