Provider Demographics
NPI:1750455804
Name:SPEDOSKE, TIMOTHY P (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:SPEDOSKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-6546
Mailing Address - Fax:517-432-9460
Practice Address - Street 1:463 E CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7500
Practice Address - Country:US
Practice Address - Phone:517-884-6546
Practice Address - Fax:517-432-9460
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS075074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080194013OtherMEDICARE RAILROAD
MIP26139FOtherBCN PIN
MI0802300731OtherBCBS INDIVIDUAL PIN
MI0802300731OtherBCBS INDIVIDUAL PIN
MIP26139FOtherBCN PIN