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General NPI Number Information
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NPI Number | 1306841382
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Entity Type | Individual
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Provider Name | TIMOTHY T O'SHEA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1201 S EUCLID AVE STE 510
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City | SIOUX FALLS
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State | SD
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Zip | 57105-0404
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Country | US
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Telephone | 605-328-7500
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Fax | 605-328-7599
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Provider Business Mailing Address
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Address Line | 2912 S HOLLY AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57105-4412
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Country | US
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Telephone | 605-336-3230
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Fax | 605-328-9501
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3534
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License Number State | SD
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