1316928161 NPI number — TIMOTHY DICKINSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316928161 NPI number — TIMOTHY DICKINSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DICKINSON

Provider First Name:

TIMOTHY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1316928161

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/07/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

551 LINN STREET

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ALLEGAN

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

49010

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

269-686-5800

Provider Business Mailing Address Fax Number:

269-686-5899

Provider First Line Business Practice Location Address:

551 LINN STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ALLEGAN

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

49010

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

269-686-5800

Provider Business Practice Location Address Fax Number:

269-686-5899

Provider Enumeration Date:

11/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  TD035680 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01-30456 . This is a "PHP PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 15403 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: TD035680 . This is a "STATE LICENSE #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 5714 . This is a "COMMUNITY CHOICE OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: P53504 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 0800307672 . This is a "BCBS MI PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 080069543 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 1276855 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 1826150 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: P00361393 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".