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General NPI Number Information
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NPI Number | 1982711628
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Entity Type | Individual
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Provider Name | TIMOTHY W TOLLESTRUP M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 3035 W HORIZON RIDGE PKWY STE 120
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City | HENDERSON
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State | NV
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Zip | 89052-4189
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Country | US
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Telephone | 702-666-0463
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Fax | 702-666-0455
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Provider Business Mailing Address
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Address Line | 3035 W HORIZON RIDGE PKWY STE 120
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City | HENDERSON
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State | NV
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Zip | 89052-4189
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Country | US
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Telephone | 702-666-0463
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Fax | 702-666-0455
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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 | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 13209
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13209
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License Number State | NV
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