Provider Demographics
NPI:1578551719
Name:TYRRELL, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:TYRRELL
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 1:120 SPALDING DRIVE
Mailing Address - Street 2:STE 303
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6557
Mailing Address - Country:US
Mailing Address - Phone:630-527-5575
Mailing Address - Fax:630-527-5573
Practice Address - Street 1:120 SPALDING DR
Practice Address - Street 2:STE 303
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6557
Practice Address - Country:US
Practice Address - Phone:630-527-5575
Practice Address - Fax:630-527-5573
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2221474OtherBCBS
IL036058551 2Medicaid
IL2221474OtherBCBS
C44730Medicare UPIN
IL110163735Medicare PIN