Provider Demographics
NPI:1922012046
Name:HORAK, TIMOTHY T (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:HORAK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1812
Mailing Address - Country:US
Mailing Address - Phone:708-799-7500
Mailing Address - Fax:708-798-4563
Practice Address - Street 1:1757 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1812
Practice Address - Country:US
Practice Address - Phone:708-799-7500
Practice Address - Fax:708-798-4563
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004735213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632534OtherBCBS
ILP00425132OtherRAILROAD MEDICARE
IL4618176OtherDEPT OF LABOR
IL4618176OtherDEPT OF LABOR
ILP00425132OtherRAILROAD MEDICARE
ILK38353Medicare PIN