Healthcare Provider Details

I. General information

NPI: 1598714958
Provider Name (Legal Business Name): TIMOTHY M. TUTHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6559 WILSON MILLS RD SUITE 106
MAYFIELD VILLAGE OH
44143-6402
US

IV. Provider business mailing address

6559 WILSON MILLS RD SUITE 106
CLEVELAND OH
44143-6402
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-1540
  • Fax: 440-460-2833
Mailing address:
  • Phone: 440-449-1540
  • Fax: 440-460-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35030473T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: