Individual
TIMOTHY R ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 GROVE AVE, WILD ROSE, WI 54984-6903
(920) 622-3257
Mailing address
601 GROVE AVE, WILD ROSE, WI 54984-6903
(920) 622-3257
(920) 787-5433
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
48464
WI
207Q00000X
Family Medicine Physician
Primary
48464
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34899200
—
WI
Enumeration date
03/10/2006
Last updated
08/04/2021
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