Healthcare Provider Details

I. General information

NPI: 1023053436
Provider Name (Legal Business Name): TIMOTHY J HULST D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E. PARIS AVE. SE STE 100
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

2144 E. PARIS AVE. SE STE 100
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-0666
  • Fax: 616-281-0752
Mailing address:
  • Phone: 616-281-0666
  • Fax: 616-281-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: