MEDICARE: TIMOTHY PATRICK PHELAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	35130966	OH
2	207RC0000X	Cardiovascular Disease Physician	35130966	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S062-0430	OTHER	MD	CAREFIRST BC/BS - REGIONAL
3	974410-01	OTHER	MD	CAREFIRST BC/BS

General Provider Information

NPI Number	:	1134388473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY PATRICK PHELAN MD

Provider Business Mailing Address
First Line	:	3425 EXECUTIVE PKWY STE 200
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 EXECUTIVE PKWY STE 200
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1333
Country	:	US
Telephone Number	:	567-638-1490
Fax Number	:	567-368-1478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	11/24/2025

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