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General NPI Number Information
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NPI Number | 1538116850
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Entity Type | Individual
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Provider Name | TIMOTHY A BURRELL MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 08/24/2024
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Provider Practice Location Address
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Address Line | 1001 N MADISON AVE
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City | GREENWOOD
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State | IN
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Zip | 46142-4135
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Country | US
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Telephone | 317-888-3508
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Fax |
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Provider Business Mailing Address
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Address Line | 2013 S RENWICK BLVD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-7167
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Country | US
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Telephone | 812-320-4183
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Fax | 812-347-4821
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01042017A
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License Number State | IN
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