Provider Demographics
NPI:1558419671
Name:SAYERS, TIMOTHY JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:SAYERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:62430 LOCUST RD LOT 69
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-9794
Mailing Address - Country:US
Mailing Address - Phone:574-231-9704
Mailing Address - Fax:574-231-9704
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1710
Practice Address - Country:US
Practice Address - Phone:269-782-8013
Practice Address - Fax:269-782-8013
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001761363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical