Provider Demographics
NPI:1184600447
Name:WESTLAKE, TIMOTHY W (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:WESTLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6400 INDUSTRIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2452
Mailing Address - Country:US
Mailing Address - Phone:414-423-4100
Mailing Address - Fax:414-423-4134
Practice Address - Street 1:791 E SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3844
Practice Address - Country:US
Practice Address - Phone:262-569-0251
Practice Address - Fax:262-569-0342
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI41233-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32580800Medicaid
WIH01678Medicare UPIN
WI0031Medicare ID - Type Unspecified