Healthcare Provider Details

I. General information

NPI: 1306227780
Provider Name (Legal Business Name): TIM MICHAEL RATLIFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18700 N 64TH DR STE 301
GLENDALE AZ
85308-7114
US

IV. Provider business mailing address

18700 N 64TH DR STE 301
GLENDALE AZ
85308-7114
US

V. Phone/Fax

Practice location:
  • Phone: 602-726-8788
  • Fax: 480-420-0732
Mailing address:
  • Phone: 602-726-8788
  • Fax: 480-420-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number008041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: