Basic Information
| Provider Information | |||||||||
| NPI: | 1154317907 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | TANSELLE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284284 | ||||||||
| FaxNumber: | 3178658355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 DARLINGTON AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479332057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653624940 | ||||||||
| FaxNumber: | 7653621302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 06/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01028702 | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 01028702A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000000175365 | 01 | IN | BCBS | OTHER | 100185470 | 05 | IN | MEDICAID | M471400010 | 01 | IN | MEDICARE PROVIDER PTAN | OTHER |