Provider Demographics
NPI:1487714606
Name:BEIDELSCHIES, TIM ARTHUR (MD)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:ARTHUR
Last Name:BEIDELSCHIES
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 1:217 N COUNTYLINE ST
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830
Mailing Address - Country:US
Mailing Address - Phone:419-435-1894
Mailing Address - Fax:419-435-4244
Practice Address - Street 1:217 N COUNTYLINE ST
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830
Practice Address - Country:US
Practice Address - Phone:419-435-1894
Practice Address - Fax:419-435-4244
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H21501Medicare UPIN
4023351Medicare PIN