Healthcare Provider Details

I. General information

NPI: 1295138725
Provider Name (Legal Business Name): AMY M TIMMINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY M BASELLE PA

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14555 LEVAN RD SUITE 311
LIVONIA MI
48154
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-2692
  • Fax: 734-655-4218
Mailing address:
  • Phone: 734-747-6766
  • Fax: 734-222-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: