Healthcare Provider Details

I. General information

NPI: 1235341330
Provider Name (Legal Business Name): TIMMEN CERMAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MILLER AVENUE SUITE #1
MILL VALLEY CA
94941
US

IV. Provider business mailing address

239 MILLER AVENUE SUITE #1
MILL VALLEY CA
94941
US

V. Phone/Fax

Practice location:
  • Phone: 415-381-4009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG-31376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: