Basic Information
| Provider Information | |||||||||
| NPI: | 1396725206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LITTLE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 S CLIFF AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640556954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515200 | ||||||||
| FaxNumber: | 8162515299 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 S CLIFF AVE | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640557015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162515200 | ||||||||
| FaxNumber: | 8162515299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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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 | R9C57 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.