Penn, Timothy J
Penn, Timothy J is an individual health care provider with primary practice located at 4802 S State Route 159 , Glen Carbon IL 62034-1904. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Penn, Timothy J can be contacted via phone (618) 288-4388.Contact Information
Primary practice address
4802 S State Route 159
Glen Carbon IL 62034-1904
Phone: (618) 288-4388
Fax: (618) 288-4927
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 036092240 | Illinois |
Profile Details
| NPI number | 1124003439 |
|---|---|
| LBN Legal business name | Penn, Timothy J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 8th, 2005 |
| Last updated | Feb 3rd, 2015 - about 9 years 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 | 1124003439 | NPPES |
| Illinois | MEDICAID | 036092240 |
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