Provider Demographics
NPI:1144485764
Name:O'DONNELL, TIMOTHY B (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:B
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:156 SAGAMORE PKWY W STE A
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1569
Mailing Address - Country:US
Mailing Address - Phone:765-204-1122
Mailing Address - Fax:765-205-8322
Practice Address - Street 1:156 SAGAMORE PKWY W STE A
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1569
Practice Address - Country:US
Practice Address - Phone:765-204-1122
Practice Address - Fax:765-205-8322
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11014237A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine