Basic Information
| Provider Information | |||||||||
| NPI: | 1346325487 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAEFER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6545 FRANCE AVE S | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202600 | ||||||||
| FaxNumber: | 9529202668 | ||||||||
| Practice Location | |||||||||
| Address1: | 6545 FRANCE AVE S | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202600 | ||||||||
| FaxNumber: | 9529202668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 053401 | GA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 577420000 | 05 | MN | MEDICAID | 060078925 | 05 | GA | MEDICAID | 34927700 | 05 | WI | MEDICAID |