Healthcare Provider Details

I. General information

NPI: 1386609071
Provider Name (Legal Business Name): TIMOTHY PATRICK WALBRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3834 S EMERSON AVE STE 100
INDIANAPOLIS IN
46203-5901
US

IV. Provider business mailing address

3834 S EMERSON AVE BUILDING C, SUITE 100
INDIANAPOLIS IN
46203-5901
US

V. Phone/Fax

Practice location:
  • Phone: 317-782-1577
  • Fax: 888-366-7577
Mailing address:
  • Phone: 317-782-1577
  • Fax: 317-780-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301088280
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA83728
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01064701A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01064701A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: