Individual
TIMOTHY MICHAEL HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4400 SHERIDAN RD, KENOSHA, WI 53140-5747
(262) 652-5454
(262) 652-5732
Mailing address
4400 SHERIDAN RD, KENOSHA, WI 53140-5747
(262) 652-5454
(262) 652-5732
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27225
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300240000
—
WI
Enumeration date
12/13/2006
Last updated
07/08/2007
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