Healthcare Provider Details

I. General information

NPI: 1821126665
Provider Name (Legal Business Name): TIMOTHY JANCELEWICZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST SUITE 230
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

51 N DUNLAP ST SUITE 230
MEMPHIS TN
38105-4625
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6031
  • Fax:
Mailing address:
  • Phone: 901-287-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA90688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49713
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number49713
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: