Provider Demographics
NPI:1578513982
Name:DEERING, TIMOTHY A MICAL (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A MICAL
Last Name:DEERING
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 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2977 COUNTY ROAD CX
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9271
Practice Address - Country:US
Practice Address - Phone:608-355-3800
Practice Address - Fax:608-355-7485
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41341-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1578513982Medicaid
WIK400176955Medicare PIN
WI1578513982Medicaid
WI1035497OtherPHYSICIANS PLUS
WI7687OtherDEAN HEALTH INSURANCE
H26773Medicare UPIN