Healthcare Provider Details

I. General information

NPI: 1568482123
Provider Name (Legal Business Name): TIM PROPECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FIRST CAPITOL DRIVE
ST CHARLES MO
63301
US

IV. Provider business mailing address

220 COMPASS POINT DR
SAINT CHARLES MO
63301-4405
US

V. Phone/Fax

Practice location:
  • Phone: 636-947-5444
  • Fax:
Mailing address:
  • Phone: 636-947-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2000151559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: