Provider Demographics
NPI:1346554466
Name:TIMBAN, TERESITA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:
Last Name:TIMBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 STEPHENSON HWY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1152
Mailing Address - Country:US
Mailing Address - Phone:248-588-0069
Mailing Address - Fax:248-581-8009
Practice Address - Street 1:850 STEPHENSON HWY
Practice Address - Street 2:SUITE 850
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1152
Practice Address - Country:US
Practice Address - Phone:248-588-0069
Practice Address - Fax:248-581-8009
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0392172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry