Provider Demographics
NPI:1811008154
Name:SCHMAKEL, TIMOTHY RAYMOND (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:SCHMAKEL
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31100 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4363
Mailing Address - Country:US
Mailing Address - Phone:248-642-2115
Mailing Address - Fax:248-642-6387
Practice Address - Street 1:31100 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4363
Practice Address - Country:US
Practice Address - Phone:248-642-2115
Practice Address - Fax:248-642-6387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI169531223S0112X
MI290106953204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI124370251Medicaid
MI104370251Medicaid
0N36170OtherMEDICARE PTAN
MI104370251Medicaid