Provider Demographics
NPI:1972592004
Name:STARNER, TIMOTHY DUANE (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DUANE
Last Name:STARNER
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 1:5522 DAHLEN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1342
Mailing Address - Country:US
Mailing Address - Phone:319-621-6170
Mailing Address - Fax:
Practice Address - Street 1:5522 DAHLEN DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1342
Practice Address - Country:US
Practice Address - Phone:319-621-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA327332080P0214X
WI70625-202080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34503500Medicaid
IA40226OtherWELLMARK BCBS
IA0235820Medicaid
IAI2115Medicare PIN