Provider Demographics
NPI:1801838784
Name:DEVITT, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:DEVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:102 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDIERS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:54655-1400
Mailing Address - Country:US
Mailing Address - Phone:608-637-4230
Mailing Address - Fax:608-637-4214
Practice Address - Street 1:102 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-1400
Practice Address - Country:US
Practice Address - Phone:608-637-4230
Practice Address - Fax:608-637-4214
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI20604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB84799Medicare UPIN