Provider Demographics
NPI:1942279260
Name:LAMB, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:LAMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42557 WOODWARD AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-253-1468
Mailing Address - Fax:248-253-1472
Practice Address - Street 1:42557 WOODWARD AVE
Practice Address - Street 2:STE 110
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-253-1468
Practice Address - Fax:248-253-1472
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI133871383468933OtherPREFERRED
MIG73589OtherHAP
MI700F375500OtherBCBSM
MI7985363OtherCIGNA
MI700F375500OtherBCN
MI104696871Medicaid
MIP00262045OtherUHC MC PALMETTO GBA
MIG73589OtherHAP
MIP00262045OtherUHC MC PALMETTO GBA