Provider Demographics
NPI:1598060428
Name:TIMOTHY P. BAESSLER, DPM, PC
Entity Type:Organization
Organization Name:TIMOTHY P. BAESSLER, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BAESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-565-5651
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:248-688-9663
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:248-688-9663
Practice Address - Fax:248-688-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001670213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty