Healthcare Provider Details

I. General information

NPI: 1558419671
Provider Name (Legal Business Name): TIMOTHY JAMES SAYERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NONE NONE NONE PA-C

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
DOWAGIAC MI
49047-1710
US

IV. Provider business mailing address

62430 LOCUST RD LOT 69
SOUTH BEND IN
46614-9794
US

V. Phone/Fax

Practice location:
  • Phone: 269-782-8013
  • Fax: 269-782-8013
Mailing address:
  • Phone: 574-231-9704
  • Fax: 574-231-9704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601001761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: