Provider Demographics
NPI:1770586737
Name:QUIST, TIMOTHY ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:QUIST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24021 US 33 EAST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517
Mailing Address - Country:US
Mailing Address - Phone:574-875-8698
Mailing Address - Fax:574-875-8749
Practice Address - Street 1:24021 US 33 EAST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517
Practice Address - Country:US
Practice Address - Phone:574-875-8698
Practice Address - Fax:574-875-8749
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000924A213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4095340001Medicare NSC
IN265580Medicare PIN
U08680Medicare UPIN