Provider Demographics
NPI:1093711491
Name:TOUGAS, TIMOTHY KEVIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KEVIN
Last Name:TOUGAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E NORTHLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8582
Mailing Address - Country:US
Mailing Address - Phone:920-731-1999
Mailing Address - Fax:920-731-3729
Practice Address - Street 1:1301 E NORTHLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8582
Practice Address - Country:US
Practice Address - Phone:920-731-1999
Practice Address - Fax:920-731-3729
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI604-025213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391776284013OtherBLUE CROSS BLUE SHIELD
WI43222200Medicaid
WIBT1034026OtherDEA NUMBER
WI391776284013OtherBLUE CROSS BLUE SHIELD
WI43222200Medicaid
WIT39093Medicare UPIN
WI391776284OtherTAX ID NUMBER