MEDICARE: DR. TIMOTHY JAMES VON FANGE 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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	01068721A	IN
2	207QS0010X	Sports Medicine (Family Medicine) Physician	036-121122	IL
3	207QS0010X	Sports Medicine (Family Medicine) Physician	01068721A	IN
4	207Q00000X	Family Medicine Physician	036-121122	IL

General Provider Information

NPI Number	:	1154461739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JAMES VON FANGE MD

Provider Business Mailing Address
First Line	:	7951 SHOAL CREEK BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7582
Country	:	US
Telephone Number	:	512-584-8404
Fax Number	:	737-377-0442

Provider Business Practice Location Address
First Line	:	2400 NORTHPARK DR STE 10
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4467
Country	:	US
Telephone Number	:	812-376-0700
Fax Number	:	812-376-8625

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	11/21/2025

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