Samelson, Timothy Charles
Samelson, Timothy Charles is an sole proprietor health care provider with primary practice located at 1425 N Hunt Club Rd Ste 204 , Gurnee IL 60031-2635. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Samelson, Timothy Charles can be contacted via phone (847) 855-2997.Contact Information
Primary practice address
1425 N Hunt Club Rd Ste 204
Gurnee IL 60031-2635
Phone: (847) 855-2997
Fax: (847) 855-8347
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 036-084135 | Illinois |
Profile Details
| NPI number | 1750381273 |
|---|---|
| LBN Legal business name | Samelson, Timothy Charles |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 27th, 2005 |
| Last updated | Dec 8th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1750381273 | NPPES |
| Illinois | MEDICAID | 364050769-60031-01 |
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