Individual
TIMOTHY D DIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9998 CROSSPOINT BLVD STE 200, INDIANAPOLIS, IN 46256-3307
(317) 579-2150
(317) 579-2130
Mailing address
9998 CROSSPOINT BLVD, STE 200, INDIANAPOLIS, IN 46256-3307
(317) 579-2150
(317) 579-2130
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01050545A
IN
2085R0202X
Diagnostic Radiology Physician
1050545
IN
2085R0204X
Vascular & Interventional Radiology Physician
01050545A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204809
ANTHEM
IN
05
—
20025310A
—
IN
01
—
300124562
RAILROAD MEDICARE
IN
01
—
300138597
RAILROAD MEDICARE
—
01
—
P000233634
RAILROAD MEDICARE
—
01
—
P00023582
RAILROAD MEDICARE
—
01
—
P00023583
RAILROAD MEDICARE
—
01
—
P00023584
RAILROAD MEDICARE
—
01
—
P00023585
RAILROAD MEDICARE
—
01
—
P00023634
RAILROAD MEDICARE
—
01
—
P00024059
RAILROAD MEDICARE
—
01
—
P00024079
RAILROAD MEDICARE
—
01
—
P00024122
RAILROAD MEDICARE
—
01
—
P00024260
RAILROAD MEDICARE
—
01
—
P00024419
RAILROAD MEDICARE
—
01
—
P00024421
RAILROAD MEDICARE
—
01
—
P00346514
RAILROAD MEDICARE
—
Enumeration date
09/01/2005
Last updated
12/24/2020
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