Individual
DR. TIMOTHY EAMON FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637
(309) 740-4272
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
036.145291
IL
207U00000X
Nuclear Medicine Physician
2018008046
MO
207U00000X
Nuclear Medicine Physician
4301501070
MI
2085N0904X
Nuclear Radiology Physician
Primary
036.145291
IL
2085N0904X
Nuclear Radiology Physician
2018008046
MO
2085N0904X
Nuclear Radiology Physician
4301501070
MI
2085R0202X
Diagnostic Radiology Physician
036.145291
IL
2085R0202X
Diagnostic Radiology Physician
2018008046
MO
2085R0202X
Diagnostic Radiology Physician
4301501070
MI
Other
Enumeration date
06/27/2012
Last updated
11/30/2023
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