Provider Demographics
NPI:1629021456
Name:HEILMAN, TIMOTHY M (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:HEILMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 RAMBLEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6384
Mailing Address - Country:US
Mailing Address - Phone:517-827-1800
Mailing Address - Fax:517-827-1642
Practice Address - Street 1:1575 RAMBLEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6384
Practice Address - Country:US
Practice Address - Phone:517-827-1800
Practice Address - Fax:517-827-1642
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013202207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4505960Medicaid
MIH70759Medicare UPIN
MI4505960Medicaid