Provider Demographics
NPI:1629013313
Name:BOLLINGER, TIMOTHY L (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3179
Mailing Address - Country:US
Mailing Address - Phone:815-578-2020
Mailing Address - Fax:815-344-4779
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-578-2020
Practice Address - Fax:815-344-4779
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106882207P00000X
WI52526-21207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIBOLLITIMOtherMERCYCARE INSURANCE
ILIL1742002Medicare UPIN
ILIL1742Medicare PIN
WIBOLLITIMOtherMERCYCARE INSURANCE
ILL95839Medicare ID - Type Unspecified
IL215660015Medicare PIN