Healthcare Provider Details

I. General information

NPI: 1407296429
Provider Name (Legal Business Name): TIMOTHY ALLEN THORNTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE
NOVI MI
48374-1233
US

IV. Provider business mailing address

3168 SOLUTIONS CENTER BOX 773168
CHICAGO IL
60677-3001
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4311
  • Fax: 248-465-4651
Mailing address:
  • Phone: 248-680-8000
  • Fax: 248-680-8030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006715
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: