Provider Demographics
NPI:1942288139
Name:MILLEA, TIMOTHY P (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:MILLEA
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 1:2300 53RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7564
Mailing Address - Country:US
Mailing Address - Phone:563-322-0971
Mailing Address - Fax:563-324-0615
Practice Address - Street 1:2300 53RD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7564
Practice Address - Country:US
Practice Address - Phone:563-322-0971
Practice Address - Fax:563-324-0615
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28751207XS0117X
IL036075860207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0084335Medicaid
1602944OtherFIRST HEALTH
IA58096OtherWELLMARK
041993OtherHEALTH ALLIANCE
IAIA0144OtherJOHN DEERE FAMILY
IL8121085OtherBCBS
200029104OtherRR MEDICARE
15561OtherMIDLANDS CHOICE
IAT80827OtherJOHN DEERE FAMILY
19769OtherIA HEALTH SOLUTIONS
IA57863OtherWELLMARK
IAT80827OtherJOHN DEERE FAMILY
IAIA0144OtherJOHN DEERE FAMILY