Provider Demographics
NPI:1376685578
Name:CORRELL, TIMOTHY ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALEXANDER
Last Name:CORRELL
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 1:950 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1818
Mailing Address - Country:US
Mailing Address - Phone:608-255-0247
Mailing Address - Fax:
Practice Address - Street 1:950 W SHORE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1818
Practice Address - Country:US
Practice Address - Phone:608-255-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB52210Medicare UPIN