Provider Demographics
NPI:1275670762
Name:BAESSLER, TIMOTHY PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:BAESSLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44199 DEQUINDRE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1128
Mailing Address - Country:US
Mailing Address - Phone:248-688-9963
Mailing Address - Fax:248-688-9665
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-688-9963
Practice Address - Fax:248-688-9665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001670213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI4437Medicare UPIN