Provider Demographics
NPI:1639171382
Name:WOISNET, TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:WOISNET
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 678950
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8950
Mailing Address - Country:US
Mailing Address - Phone:440-245-4480
Mailing Address - Fax:440-245-4484
Practice Address - Street 1:221 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1817
Practice Address - Country:US
Practice Address - Phone:440-245-4480
Practice Address - Fax:440-245-4484
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350628462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2433218Medicaid
E29648Medicare UPIN
OHWO0638809Medicare ID - Type Unspecified