Provider Demographics
NPI:1790465987
Name:TIMILA, DIPSAL
Entity Type:Individual
Prefix:
First Name:DIPSAL
Middle Name:
Last Name:TIMILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SPARROW HEALTH SYSTEMS
Mailing Address - Street 2:1215 E MICHIGAN AVENUE
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SPARROW HEALTH SYSTEMS
Practice Address - Street 2:1215 E MICHIGAN AVENUE
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48909
Practice Address - Country:US
Practice Address - Phone:517-974-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351050832APP23208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics