Healthcare Provider Details

I. General information

NPI: 1790465987
Provider Name (Legal Business Name): DIPSAL TIMILA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPARROW HEALTH SYSTEMS 1215 E MICHIGAN AVENUE
LANSING MI
48909
US

IV. Provider business mailing address

SPARROW HEALTH SYSTEMS 1215 E MICHIGAN AVENUE
LANSING MI
48909
US

V. Phone/Fax

Practice location:
  • Phone: 517-974-4374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351050832APP23
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: