MEDICARE: MR. TIMOTHY R. WEICHERT DO, PHD,FACOI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101012287	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110152828	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1152800585	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114986098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY R. WEICHERT DO, PHD,FACOI

Provider Business Mailing Address
First Line	:	3537 W FRONT ST STE I
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9651
Country	:	US
Telephone Number	:	231-935-8950
Fax Number	:	231-935-8868

Provider Business Practice Location Address
First Line	:	3537 W FRONT ST STE I
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-9651
Country	:	US
Telephone Number	:	231-935-8950
Fax Number	:	231-935-8868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	11/12/2020

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Directions to “ MR. TIMOTHY R. WEICHERT DO, PHD,FACOI” Practice Location

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