MEDICARE: PETER W TIMMERMANS 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	207Q00000X	Family Medicine Physician	23519	WI

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

General Provider Information

NPI Number	:	1346223690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER W TIMMERMANS MD

Provider Business Mailing Address
First Line	:	420 E DIVISION ST
Second Line	:
City	:	FOND DU LAC
State	:	WI
Zip	:	54935-4560
Country	:	US
Telephone Number	:	920-926-8340
Fax Number	:	920-926-8370

Provider Business Practice Location Address
First Line	:	608 W BROWN ST
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-1702
Country	:	US
Telephone Number	:	920-324-6801
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	12/15/2021

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