Provider Demographics
NPI:1376760991
Name:HUYCK, TIMOTHY K (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:K
Last Name:HUYCK
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 1:611 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5706
Mailing Address - Country:US
Mailing Address - Phone:402-593-3141
Mailing Address - Fax:
Practice Address - Street 1:611 FENWICK DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5706
Practice Address - Country:US
Practice Address - Phone:402-593-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086200010Medicare PIN