Healthcare Provider Details

I. General information

NPI: 1477554277
Provider Name (Legal Business Name): TIMOTHY MATTHEW ISERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 CARMEL ST
CADILLAC MI
49601-2547
US

IV. Provider business mailing address

927 S CARMEL ST
CADILLAC MI
49601-2547
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-3876
  • Fax: 231-775-1115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD22588
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM7982
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301065506
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: