Provider Demographics
NPI:1760441927
Name:MARTIN, TIMOTHY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:MARTIN
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 1:350 N GRANDVIEW AVE
Mailing Address - Street 2:SUITE G3300
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6388
Mailing Address - Country:US
Mailing Address - Phone:563-589-2557
Mailing Address - Fax:563-589-2665
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:SUITE G3300
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6388
Practice Address - Country:US
Practice Address - Phone:563-589-2557
Practice Address - Fax:563-589-2665
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25710207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2096263Medicaid
WI32105100Medicaid
50892Medicare PIN
IAF55186Medicare UPIN