Provider Demographics
NPI:1215904115
Name:ARNOLD, TIMOTHY J (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1865
Mailing Address - Country:US
Mailing Address - Phone:218-927-2157
Mailing Address - Fax:218-927-4130
Practice Address - Street 1:200 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1865
Practice Address - Country:US
Practice Address - Phone:218-927-2157
Practice Address - Fax:218-927-4130
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN720027700Medicaid
MN080015843Medicare ID - Type UnspecifiedWPS GARRISON CLINIC
MN080010191Medicare ID - Type UnspecifiedWPS MCGREGOR CLINIC
MN720027700Medicaid
MN080010190Medicare ID - Type UnspecifiedWPS AITKIN CLINIC
MN080010189Medicare ID - Type UnspecifiedWPS HOSPITAL