Provider Demographics
NPI:1275390791
Name:DORNISCH, TIM JOHN
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:JOHN
Last Name:DORNISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4441 GAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3809
Mailing Address - Country:US
Mailing Address - Phone:952-239-9369
Mailing Address - Fax:
Practice Address - Street 1:4441 GAYWOOD DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-3809
Practice Address - Country:US
Practice Address - Phone:952-239-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNBC692986171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications