Provider Demographics
NPI:1568576775
Name:HENSCHEL, TIMOTHY M (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:HENSCHEL
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 1:1370 GATEWAY BLVD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-790-0567
Mailing Address - Fax:615-595-8030
Practice Address - Street 1:1370 GATEWAY BLVD.
Practice Address - Street 2:SUITE 110
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-890-9008
Practice Address - Fax:615-890-0193
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3132045OtherBLUE CROSS BLUE SHIELD
TN3898088Medicaid
TN4384713OtherAETNA
TN9381502OtherCIGNA
TN1240364OtherUNITED HEALTHCARE
TN30632OtherMEDICAL LICENSE #
TN1240364OtherUNITED HEALTHCARE