Healthcare Provider Details

I. General information

NPI: 1275670762
Provider Name (Legal Business Name): TIMOTHY PATRICK BAESSLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 NEARBROOK RD
BLOOMFIELD TOWNSHIP MI
48302-2137
US

IV. Provider business mailing address

4118 NEARBROOK RD
BLOOMFIELD TOWNSHIP MI
48302-2137
US

V. Phone/Fax

Practice location:
  • Phone: 248-565-5651
  • Fax:
Mailing address:
  • Phone: 248-565-5651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: