DR. TIMOTHY CHARLES SAMELSON (NPI# 1750381273) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750381273 |
| Entity Type | Individual |
| Full Name | DR. TIMOTHY CHARLES SAMELSON |
| Credential | M.D. |
| Practice Address |
6440 Grand Ave Suite 202 Gurnee IL 60031-5257 |
| Practice Telephone | 8478552997 |
| Practice Fax Number | 8478558347 |
| Mailing Telephone | 8478552997 |
| Mailing Fax Number | 8478558347 |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 036-084135 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 364050769-60031-01 | 05 |
| Street Address |
6440 GRAND AVE SUITE 202 |
| City | GURNEE |
| State | IL |
| Zip Code | 60031-5257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972744027 | Midwest Sleep Medical Equipment | Durable Medical Equipment & Medical Supplies | 6440 Grand Ave, 203, Gurnee, IL 60031-5257 | 2009-03-19 |
| 1043482250 | Hosep H Deyrmenjian, Md, PC | Internal Medicine | 6440 Grand Ave, Suite 205, Gurnee, IL 60031-5257 | 2008-03-27 |
| 1538347406 | Uropartners LLC | Urology | 6440 Grand Ave, Suite 206, Gurnee, IL 60031-5257 | 2008-02-03 |
| 1871637454 | Bruce A. Brown, M.d., S.c. | Specialist | 6440 Grand Ave, Suite 206, Gurnee, IL 60031-5257 | 2007-02-16 |
| 1912923269 | Bruce Allen Brown | Urology | 6440 Grand Ave, Suite 206, Gurnee, IL 60031-5257 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881174720 | Rockelle Waggoner | Behavioral Analyst | 489 Tanglewood Dr, Gurnee, IL 60031 | 2018-08-20 |
| 1316434376 | Lake County Internal Medicine Assoc LLC | Non-Pharmacy Dispensing Site | 15 Tower Ct., Ste 190, Gurnee, IL 60031 | 2018-04-16 |
| 1588163364 | Advanced Endodontics, PC | Dentist | 103 S. Greenleaf Street, Suite K, Gurnee, IL 60031 | 2018-02-07 |
| 1578081550 | Northshore Medical Consultants, Ltd | Family Medicine | 1425 Hunt Club Rd. #302, Gurnee, IL 60031 | 2017-08-30 |
| 1336678739 | Sarah Beth Fugelseth | Nurse Practitioner | 1445 N Hunt Club Rd Ste 304, Gurnee, IL 60031 | 2017-06-08 |
| 1174079867 | Lifecarepros, LLC | In Home Supportive Care | 223 North Route 21, Gurnee, IL 60031 | 2016-09-01 |
| 1740733195 | Ryan Lee Winslow | Chiropractor | 6021 Washington St, Unit B, Gurnee, IL 60031 | 2016-08-02 |
| 1891129599 | Smart Scan Mri, LLC | Clinic/Center | 350 S. Greenleaf, Suite 401, Gurnee, IL 60031 | 2013-08-29 |
| 1568720076 | Yudelca Romano | Genetic Counselor, MS | 1125 Tri State Parkway, Gurnee, IL 60031 | 2012-05-03 |
| 1558637348 | Laura E Novak | Social Worker | 4212 Old Grand Avenue, Gurnne, IL 60031 | 2012-03-27 |
| Find all providers in zip 60031 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114102530 | Lake County Pediatrics Sc | Pediatrics | 200 S Greenleaf Ave, Suite E, Gurnee, IL 60031 | 2008-01-03 |
| 1083782908 | Marlene Juco Tanquilut | Pediatrics | 200 South Greenleaf St, Suite E, Gurnee, IL 60031 | 2006-11-30 |
| 1679567747 | Barry Goldman | Pediatrics | 15 Tower Ct, Suite 100, Gurnee, IL 60031-3336 | 2005-09-06 |
| 1609280502 | Diana Maniev | Pediatrics | 6475 Washington St Ste 103, Gurnee, IL 60031-4404 | 2014-06-18 |
| 1881947679 | Amna Khan | Pediatrics | 15 Tower Ct Ste 100, Gurnee, IL 60031 | 2012-10-18 |
| 1770897696 | Bright Horizons Pediatrics | Pediatrics | 1790 Nations Dr, Suite 207, Gurnee, IL 60031-9164 | 2010-08-03 |
| 1891944666 | Marson Tenoso | Pediatrics | 15 Tower Ct, Suite 150, Gurnee, IL 60031-3336 | 2008-09-16 |
| 1366510281 | Albino Tirao Bismonte | Pediatrics | 200 S Greenleaf St, Suite E, Gurnee, IL 60031 | 2006-11-30 |
| 1811085053 | Faye S Montes | Pediatrics | 15 Tower Ct, Suite 150, Gurnee, IL 60031 | 2006-10-11 |
| 1366530503 | Alma Guzman | Pediatrics | 15 Tower Ct, Suite 150, Gurnee, IL 60031 | 2006-10-11 |
| Find all providers in GURNEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.