Daugherty, Timothy
Daugherty, Timothy is an sole proprietor health care provider with primary practice located at 747 N Rutledge St Fl 3 , Springfield IL 62702-6700. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Daugherty, Timothy can be contacted via phone (217) 545-8000.Contact Information
Primary practice address
747 N Rutledge St Fl 3
Springfield IL 62702-6700
Phone: (217) 545-8000
Fax: (217) 545-2588
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | 036.160543 | Illinois |
| Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery | 2086S0122X | 125.066594 | Illinois |
Profile Details
| NPI number | 1780066738 |
|---|---|
| LBN Legal business name | Daugherty, Timothy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 26th, 2015 |
| Last updated | Jan 29th, 2024 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780066738 | NPPES |
| Illinois | MEDICAID | 125066594 |
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