Provider Demographics
NPI:1265541981
Name:RAYKOVICH, TIMOTHY W (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:RAYKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:833 W LINCOLN HWY
Mailing Address - Street 2:SUITE 200W
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1683
Mailing Address - Country:US
Mailing Address - Phone:219-934-5300
Mailing Address - Fax:219-934-5389
Practice Address - Street 1:757 45TH
Practice Address - Street 2:SUITE 201
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-922-5550
Practice Address - Fax:219-922-5555
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025435A207R00000X
IN01025435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB29127Medicare UPIN
IN387080BMedicare ID - Type Unspecified