Individual
TIMOTHY WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-5429
(309) 655-2000
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35.123822
OH
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036-132985
IL
2085R0204X
Vascular & Interventional Radiology Physician
35.123822
OH
2085R0204X
Vascular & Interventional Radiology Physician
82252
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104941
—
OH
01
—
35.123822
LICENSE
OH
Enumeration date
06/07/2008
Last updated
10/13/2023
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