Provider Demographics
NPI:1598835837
Name:CHAMBERLAIN, TIMOTHY S (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:CHAMBERLAIN
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 1:701 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PROPHETSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:61277-1334
Mailing Address - Country:US
Mailing Address - Phone:815-537-5168
Mailing Address - Fax:815-537-5268
Practice Address - Street 1:701 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PROPHETSTOWN
Practice Address - State:IL
Practice Address - Zip Code:61277-1334
Practice Address - Country:US
Practice Address - Phone:815-537-5168
Practice Address - Fax:815-537-5268
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36103082Medicaid
ILP00426402OtherMEDICARE- RAILROAD
IL36103082Medicaid
ILP00426402OtherMEDICARE- RAILROAD