Individual
TIMOTHY A. SANBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143
(262) 653-3650
(262) 656-3672
Mailing address
7901 S 6TH ST, OAK CREEK, WI 53154-2010
(414) 346-8000
(414) 346-8010
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036102493
IL
207RC0000X
Cardiovascular Disease Physician
Primary
69326
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073600987
—
WI
Enumeration date
10/10/2006
Last updated
07/25/2018
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