Provider Demographics
NPI:1376531632
Name:CHESTNUT, TIMOTHY MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:CHESTNUT
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 1:7209 S. SOUTH MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223
Mailing Address - Country:US
Mailing Address - Phone:509-994-5442
Mailing Address - Fax:509-448-8917
Practice Address - Street 1:7209 S. SOUTH MEADOWS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-994-5442
Practice Address - Fax:509-448-8917
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020134207RC0200X, 207RP1001X
WAMD 00020134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066984Medicaid
WA000302502Medicare ID - Type Unspecified
WA1066984Medicaid
A04249Medicare UPIN