Healthcare Provider Details

I. General information

NPI: 1952684698
Provider Name (Legal Business Name): DR. TIMOTHY J DAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DWYER ST
CLARE MI
48617-1002
US

IV. Provider business mailing address

125 DWYER ST
CLARE MI
48617-1002
US

V. Phone/Fax

Practice location:
  • Phone: 989-386-9721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4964
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: