Provider Demographics
NPI:1730109000
Name:MAHER, TIMOTHY J (D P M P A)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:MAHER
Suffix:
Gender:M
Credentials:D P M P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 83RD WAY N
Mailing Address - Street 2:SUITR 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:
Practice Address - Street 1:13800 83RD WAY N
Practice Address - Street 2:SUITR 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:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN401213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04332Medicare Oscar/Certification
MNC04333Medicare Oscar/Certification