Basic Information
| Provider Information | |||||||||
| NPI: | 1285611442 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NOVEROSKE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742361888 | ||||||||
| FaxNumber: | 5742361887 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742361888 | ||||||||
| FaxNumber: | 5742361887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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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 | 2086S0129X | 01038790A | IN | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.