Provider Demographics
NPI:1659302263
Name:LYMAN, TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LYMAN
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 1:1130 S MICHIGAN AVE
Mailing Address - Street 2:4104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2521
Mailing Address - Country:US
Mailing Address - Phone:312-427-6093
Mailing Address - Fax:708-453-4660
Practice Address - Street 1:RESURRECTION IMMEDIATE CARE CENTER
Practice Address - Street 2:7230 W. NORTH AVE STE 106 B
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4262
Practice Address - Country:US
Practice Address - Phone:708-453-3000
Practice Address - Fax:708-453-4660
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336029683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065300Medicaid
1619414OtherBCBS GROUP
1619414OtherBCBS GROUP
IL036065300Medicaid
K52758 EP/DPMedicare PIN
K53677 ICCMedicare PIN