Provider Demographics
NPI:1225078157
Name:ZIOLKOWSKI, TIMOTHY J (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:ZIOLKOWSKI
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 1:5454 NEW CUT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-361-9947
Practice Address - Street 1:200 ABRAHAM FLEXNOR WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-361-9900
Practice Address - Fax:502-361-9947
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39137207P00000X
WV27164207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000057678OtherANTHEM
KY64104565Medicaid
KY50010463OtherPASSPORT
KY610893149001OtherTRICARE
KYP00320032OtherRAILROAD MEDICARE
IN200818370Medicaid
KY2711345000OtherPASSPORT ADVANTAGE
KY610893149OtherHUMANA
KY610893149001OtherTRICARE
KY000000057678OtherANTHEM