Provider Demographics
NPI:1063475689
Name:ELLIOTT, TIMOTHY H (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-0331
Mailing Address - Country:US
Mailing Address - Phone:913-469-4244
Mailing Address - Fax:913-469-1939
Practice Address - Street 1:8929 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1689
Practice Address - Country:US
Practice Address - Phone:913-596-4180
Practice Address - Fax:913-596-4797
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS426615207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100192390BMedicaid
KSJ679359Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KSJ679359Medicare PIN