Healthcare Provider Details

I. General information

NPI: 1760352769
Provider Name (Legal Business Name): TIMOTHY FAASSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 4 MILE RD NW
GRAND RAPIDS MI
49544-8252
US

IV. Provider business mailing address

3281 WOODWIND DR NE
GRAND RAPIDS MI
49525-9751
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-6299
  • Fax:
Mailing address:
  • Phone: 616-666-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3502013324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: