Provider Demographics
NPI:1396792255
Name:MCAVOY, TIMOTHY GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GERARD
Last Name:MCAVOY
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 1:1751 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3940
Mailing Address - Country:US
Mailing Address - Phone:262-547-0000
Mailing Address - Fax:262-547-0157
Practice Address - Street 1:1751 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3940
Practice Address - Country:US
Practice Address - Phone:262-547-0000
Practice Address - Fax:262-547-0157
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B54916Medicare UPIN