Healthcare Provider Details

I. General information

NPI: 1023942463
Provider Name (Legal Business Name): TIMOTHY ALLAN COLLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 VALLEY VIEW DR
TRAVERSE CITY MI
49685-8744
US

IV. Provider business mailing address

903 VALLEY VIEW DR
TRAVERSE CITY MI
49685-8744
US

V. Phone/Fax

Practice location:
  • Phone: 231-499-0269
  • Fax: 231-499-0269
Mailing address:
  • Phone: 231-499-0269
  • Fax: 231-499-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number5802000150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: