MEDICARE: SANFORD M TIMEN M.D.

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	207Y00000X	Otolaryngology Physician	35043345	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750382230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANFORD M TIMEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 567
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-0567
Country	:	US
Telephone Number	:	216-464-5160
Fax Number	:	216-464-5982

Provider Business Practice Location Address
First Line	:	5400 TRANSPORTATION BLVD
Second Line	:	SUITE 11
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-5324
Country	:	US
Telephone Number	:	216-662-9363
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/09/2007

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