Provider Demographics
NPI:1386861102
Name:TIMOTHY G MCAVOY MD SC
Entity Type:Organization
Organization Name:TIMOTHY G MCAVOY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-547-0000
Mailing Address - Street 1:1751 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3940
Mailing Address - Country:US
Mailing Address - Phone:262-547-0000
Mailing Address - Fax:262-547-0157
Practice Address - Street 1:1751 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3940
Practice Address - Country:US
Practice Address - Phone:262-547-0000
Practice Address - Fax:262-547-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty