Provider Demographics
NPI:1194221754
Name:WAITS, TIMOTHY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:WAITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 THOMAS MORE PKWY STE 209
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2175
Mailing Address - Country:US
Mailing Address - Phone:859-578-5860
Mailing Address - Fax:859-341-4845
Practice Address - Street 1:375 THOMAS MORE PKWY STE 209
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2175
Practice Address - Country:US
Practice Address - Phone:859-578-5860
Practice Address - Fax:859-341-4845
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.1474442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program