Individual
TIMOTHY J NUSSBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1703 W STONES CROSSING RD STE 200, GREENWOOD, IN 46143-8558
(317) 859-3737
(317) 859-3730
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036991A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067820
—
IN
Enumeration date
11/18/2005
Last updated
10/13/2023
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