MEDICARE: TIMOTHY T HORAK DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016-004735	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00425132	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632534	OTHER	IL	BCBS
3	4618176	OTHER	IL	DEPT OF LABOR

General Provider Information

NPI Number	:	1922012046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY T HORAK DPM

Provider Business Mailing Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	708-798-4563

Provider Business Practice Location Address
First Line	:	1757 RIDGE RD
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-1812
Country	:	US
Telephone Number	:	708-799-7500
Fax Number	:	708-798-4563

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/15/2013

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Directions to “ TIMOTHY T HORAK DPM” Practice Location

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