Provider Demographics
NPI:1316160328
Name:NUSH, TIMOTHY W (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:NUSH
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:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46527-0834
Mailing Address - Country:US
Mailing Address - Phone:574-364-2875
Mailing Address - Fax:
Practice Address - Street 1:2016 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-5236
Practice Address - Country:US
Practice Address - Phone:574-533-7600
Practice Address - Fax:574-533-7666
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066665A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2009935890Medicaid
IN2009935890Medicaid