Provider Demographics
NPI:1982692521
Name:HUSCHKE, TIMOTHY J (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HUSCHKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINDERLEY PL
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7247
Mailing Address - Country:US
Mailing Address - Phone:407-875-8784
Mailing Address - Fax:
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8731207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264608100Medicaid
FL62671OtherBLUE CROSS
G19386Medicare UPIN
FL62671ZMedicare PIN
P00604561Medicare PIN
FL62671VMedicare PIN