MEDICARE: DR. TIMOTHY WILLINGHAM 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	207R00000X	Internal Medicine Physician	ME81440	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51864	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184676132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY WILLINGHAM MD

Provider Business Mailing Address
First Line	:	4611 OKEECHOBEE BLVD
Second Line	:	SUITE 110
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4637
Country	:	US
Telephone Number	:	561-408-9444
Fax Number	:	561-689-7500

Provider Business Practice Location Address
First Line	:	4611 OKEECHOBEE BLVD
Second Line	:	SUITE 110
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4637
Country	:	US
Telephone Number	:	561-408-9444
Fax Number	:	561-689-7500

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/07/2014

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