Active NPI
Alexander Mueller Timchak, M.D.
- Psychiatry Physician
- Northbrook, IL
National Provider Identifier
1174752000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 125056153
- Practice address
- 60 Revere Dr Ste 100
Northbrook, IL 60062-1590 - Phone
- (122) 430-6187
- NPI assigned
- Jul 13, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 036.129063 | IL | |
| Psychiatry Physician | 2084P0800X | 125056153 | IL | Primary |
Addresses
Primary practice location
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Mailing address
60 Revere Dr Ste 100
Northbrook, IL 60062-1590
Phone (224) 306-1879
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Previously, effective Jul 31, 2014 through Jul 31, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125056153 | IL | MD | Psychiatry Physician |
| 036.129063 | IL | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704153600000",
"number": "1174752000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "224-306-1879",
"fax_number": "224-306-1878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 REVERE DR STE 100",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600621590",
"telephone_number": "122-430-6187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMCHAK",
"first_name": "ALEXANDER",
"middle_name": "MUELLER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-13",
"last_updated": "2024-01-02",
"certification_date": "2024-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IL",
"license": "036.129063",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "125056153",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.