Provider Demographics
NPI:1831249481
Name:HALLORAN, TIMOTHY J (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HALLORAN
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 1:700 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1000
Mailing Address - Country:US
Mailing Address - Phone:952-873-2276
Mailing Address - Fax:952-873-4222
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LE SUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-5500
Practice Address - Country:US
Practice Address - Phone:507-665-4017
Practice Address - Fax:507-665-4019
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN273301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN226268100Medicaid