Healthcare Provider Details

I. General information

NPI: 1184458689
Provider Name (Legal Business Name): FARRAH BROOKE TIMMOL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 CLIFTON RDG
HIGHLAND MI
48357-2811
US

IV. Provider business mailing address

2330 S MILFORD RD STE 120
HIGHLAND MI
48357-4982
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-4734
  • Fax:
Mailing address:
  • Phone: 248-676-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: