Provider Demographics
NPI:1427799980
Name:CRULL, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:CRULL
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:WILDWOOD MEDICAL CENTER
Mailing Address - Street 2:2865 N REYNOLDS RD, SUITE 170
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2076
Mailing Address - Country:US
Mailing Address - Phone:419-578-7510
Mailing Address - Fax:419-537-5606
Practice Address - Street 1:2865 N REYNOLDS RD STE 170
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2076
Practice Address - Country:US
Practice Address - Phone:419-578-7510
Practice Address - Fax:419-537-5606
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091099A207P00000X
390200000X
OH35.153063207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program