Provider Demographics
NPI:1740827724
Name:HOLDEN, TIMOTHY W (NP-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 CHURCHHILL LN APT 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-6914
Mailing Address - Country:US
Mailing Address - Phone:989-284-9024
Mailing Address - Fax:
Practice Address - Street 1:4005 ORCHARD DR MIDLAND
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48670-0001
Practice Address - Country:US
Practice Address - Phone:989-839-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318470207Q00000X
MI4704318470NSA190VX207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty