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Individual

TIMOTHY R TANSELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1500 DARLINGTON AVE, STE 300, CRAWFORDSVILLE, IN 47933-2057
(765) 362-4940
(765) 362-1302
Mailing address
1040 SIERRA DRIVE, SUITE 400, GREENWOOD, IN 46143-7241
(317) 528-4284
(317) 865-8355

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028702
IN
208M00000X
Hospitalist Physician
01028702A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000175365
BCBS
IN
05
100185470
IN
01
M471400010
MEDICARE PROVIDER PTAN
IN
Enumeration date
09/26/2005
Last updated
06/13/2014
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