Provider Demographics
NPI:1689825010
Name:TULLY, TIMOTHY EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:TULLY
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 1:47545 CHAPINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:WI
Mailing Address - Zip Code:54821-3409
Mailing Address - Country:US
Mailing Address - Phone:715-798-4825
Mailing Address - Fax:
Practice Address - Street 1:47545 CHAPINWOOD RD
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:WI
Practice Address - Zip Code:54821-3409
Practice Address - Country:US
Practice Address - Phone:715-798-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18196-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology