MEDICARE: DR. TIMOTHY PETER BOUFFORD 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	207R00000X	Internal Medicine Physician	4301062476	MI
2	208M00000X	Hospitalist Physician	4301062476	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70-0-F32947-0	OTHER	MI	BCBS CPIN #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1811991177	OTHER	MI	NPI #
4	TB062476	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1811991177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY PETER BOUFFORD M.D.

Provider Business Mailing Address
First Line	:	36115 SCHOOLCRAFT RD
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150-1216
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

Provider Business Practice Location Address
First Line	:	15855 19 MILE RD
Second Line	:	HENRY FORD MACOMB
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:	734-464-0887
Fax Number	:	734-402-0254

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/08/2014

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Directions to “ DR. TIMOTHY PETER BOUFFORD M.D.” Practice Location

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