Individual
NICHOLAS STORM TIMMERWILKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2115
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2022012028
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2019
Last updated
08/08/2022
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