Healthcare Provider Details

I. General information

NPI: 1790465987
Provider Name (Legal Business Name): DIPSAL TIMILA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E WARWICK DR STE D
ALMA MI
48801-1083
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-466-7285
  • Fax:
Mailing address:
  • Phone: 844-832-1956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301517690
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: