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General NPI Number Information
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NPI Number | 1205397502
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Entity Type | Individual
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Provider Name | TIMOTHY D ZELLMER MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST STE 800
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City | CHICAGO
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State | IL
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Zip | 60611-2978
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Country | US
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Telephone | 312-926-4068
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Fax | 312-695-5645
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST STE 800
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City | CHICAGO
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State | IL
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Zip | 60611-2978
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Country | US
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Telephone | 312-926-4068
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Fax | 312-695-5645
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036168145
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License Number State | IL
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