Individual
DR. TIMOTHY PHILIP HALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1634 W POLK ST, STATION A, CHICAGO, IL 60612-4352
(312) 423-4200
Mailing address
1634 W POLK ST, STATION A, CHICAGO, IL 60612-4352
(312) 423-4200
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036124084
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20015920
—
IL
Enumeration date
07/18/2008
Last updated
04/04/2014
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