Healthcare Provider Details

I. General information

NPI: 1285966580
Provider Name (Legal Business Name): TIMOTHY PAUL DEUTSCHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 GUION RD
INDIANAPOLIS IN
46222-1616
US

IV. Provider business mailing address

1940 RUNAWAY BAY LN APT L
INDIANAPOLIS IN
46224-8863
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-8439
  • Fax:
Mailing address:
  • Phone: 515-401-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11015178A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: