Provider Demographics
NPI:1003802141
Name:PLANK, TIMOTHY (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:PLANK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1849
Mailing Address - Country:US
Mailing Address - Phone:419-626-5623
Mailing Address - Fax:419-626-8778
Practice Address - Street 1:420 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1849
Practice Address - Country:US
Practice Address - Phone:419-626-5623
Practice Address - Fax:419-626-8778
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860564Medicaid
OH0860564Medicaid
OHF02152Medicare UPIN