Provider Demographics
NPI:1639183114
Name:TIMOTHY J MAHER D P M P A
Entity Type:Organization
Organization Name:TIMOTHY J MAHER D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:763-420-7855
Mailing Address - Street 1:13800 83RD WAY N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7016
Mailing Address - Country:US
Mailing Address - Phone:763-420-7855
Mailing Address - Fax:763-420-2043
Practice Address - Street 1:13800 83RD WAY N
Practice Address - Street 2:SUITE 104
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7016
Practice Address - Country:US
Practice Address - Phone:763-420-7855
Practice Address - Fax:763-420-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN401213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty