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General NPI Number Information
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NPI Number | 1154461739
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES VON FANGE MD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 2400 NORTHPARK DR STE 10
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City | COLUMBUS
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State | IN
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Zip | 47203-4467
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Country | US
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Telephone | 812-376-0700
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Fax | 812-376-8625
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Provider Business Mailing Address
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Address Line | 7951 SHOAL CREEK BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78757-7582
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Country | US
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Telephone | 512-584-8404
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Fax | 737-377-0442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 01068721A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036-121122
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 01068721A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-121122
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License Number State | IL
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