Healthcare Provider Details

I. General information

NPI: 1831249481
Provider Name (Legal Business Name): TIMOTHY J HALLORAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST SUITE 101
LE SUEUR MN
56058-5500
US

IV. Provider business mailing address

700 W PRAIRIE ST
BELLE PLAINE MN
56011-1000
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-4017
  • Fax: 507-665-4019
Mailing address:
  • Phone: 952-873-2276
  • Fax: 952-873-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number273301
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: