Individual
DR. TIMOTHY DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
747 N RUTLEDGE ST FL 3, SPRINGFIELD, IL 62702-6700
(217) 545-8000
(217) 545-2588
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036.160543
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
125.066594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125066594
—
IL
Enumeration date
06/26/2015
Last updated
01/29/2024
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