Provider Demographics
NPI:1033893078
Name:HIGH, TIMOTHY R (NP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:HIGH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W CERMAK RD STE 3D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2268
Mailing Address - Country:US
Mailing Address - Phone:312-883-8664
Mailing Address - Fax:
Practice Address - Street 1:600 W CERMAK RD STE 3D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2268
Practice Address - Country:US
Practice Address - Phone:773-972-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026048363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology