Provider Demographics
NPI:1750474326
Name:WILLIAMSON, TIMOTHY L (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:L
Last Name:WILLIAMSON
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6045
Mailing Address - Fax:913-588-4098
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:DEPT OF INTERNAL MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6045
Practice Address - Fax:913-588-4098
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27184207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209045301Medicaid
KS100458210AMedicaid
MO32714011OtherBCBS KC
KS417951OtherFIRSTGUARD
H62363Medicare UPIN
KS100458210AMedicaid
KSP00034817Medicare ID - Type UnspecifiedRAILROAD MEDICARE