Individual
PAUL E TIMPERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01046831A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188818
ANTHEM PROVIDER NUMBER
IN
01
—
10826092
CAQH NUMBER
IN
05
—
200166040
—
IN
01
—
9274773
PHCS PID NUMBER
IN
Enumeration date
03/23/2006
Last updated
02/26/2021
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