Healthcare Provider Details

I. General information

NPI: 1639121684
Provider Name (Legal Business Name): TIMOTHY E DICKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 NORTHWEST BLVD.
INDIANAPOLIS IN
46278-1381
US

IV. Provider business mailing address

8450 NORTHWEST BLVD.
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-2000
  • Fax: 317-802-2170
Mailing address:
  • Phone: 317-802-8000
  • Fax: 317-802-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01041157A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number01041157
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: