Provider Demographics
NPI:1598873499
Name:LENARDO, TIMOTHY M (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:LENARDO
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:PO BOX 19248
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:800 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3778
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052358A207RR0500X
IL036096818207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0182863OtherUS DEPT OF LABOR
IN200280460Medicaid
660003840OtherRAILROAD MCARE PALAMETTO
IN200280460TMedicaid
351904269144OtherCARESOURCE MEDICAID
434234OtherHEALTHLINK
660002980OtherRAILROAD MCARE PALAMETTO
000000089626OtherANTHEM
IN200280460BOtherMOLINA HEALTHCARE MCAID
4024986OtherCIGNA
7299112OtherAETNA
INP00818720OtherRAILROAD MEDICARE
INN283320OtherHARMONY HEALTH PLAN IND
INN283320OtherHARMONY HEALTH PLAN IND
434234OtherHEALTHLINK
IN200280460Medicaid
IN192770DMedicare PIN