Healthcare Provider Details

I. General information

NPI: 1245248327
Provider Name (Legal Business Name): TIMOTHY FRANCIS HOGAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41820 6 MILE RD STE 104
NORTHVILLE MI
48168-2771
US

IV. Provider business mailing address

41820 6 MILE RD STE 104
NORTHVILLE MI
48168-2771
US

V. Phone/Fax

Practice location:
  • Phone: 248-349-3131
  • Fax: 248-349-3232
Mailing address:
  • Phone: 248-349-3131
  • Fax: 248-349-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301009432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: