Provider Demographics
NPI:1114442472
Name:TIMM, JONATHAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CHRISTOPHER
Last Name:TIMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1408
Mailing Address - Country:US
Mailing Address - Phone:734-845-1353
Mailing Address - Fax:
Practice Address - Street 1:219 BIDWELL ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1408
Practice Address - Country:US
Practice Address - Phone:734-845-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1609135748Medicaid