Provider Demographics
NPI:1659365443
Name:PAGE, TIMOTHY P (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S ADAMS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7005
Mailing Address - Country:US
Mailing Address - Phone:248-644-8060
Mailing Address - Fax:248-644-5081
Practice Address - Street 1:800 S ADAMS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7005
Practice Address - Country:US
Practice Address - Phone:248-644-8060
Practice Address - Fax:248-644-5081
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITP063398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F37296005OtherRAILROAD MEDICARE
381867275OtherPPOM
381867275OtherAETNA
381867275OtherHARRINGTON BENEFITS
MI4179882Medicaid
381867275OtherWPS TRICARE FOR LIFE
381867275OtherFIRST HEALTH
G76707OtherHAP
381867275OtherCIGNA
381867275OtherGREAT LAKES
381867275OtherUNITED HEALTHCARE
MI0F37296OtherBCBSM
C6939OtherMCARE
180F372960OtherBLUE CARE NETWORK
MI4179882Medicaid
MI0F37296Medicare PIN
381867275OtherWPS TRICARE FOR LIFE
MI0F37296Medicare ID - Type Unspecified