Healthcare Provider Details

I. General information

NPI: 1417987256
Provider Name (Legal Business Name): TROY TIMKO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

IV. Provider business mailing address

5300 ELLIOTT DR
YPSILANTI MI
48197-8632
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6262
  • Fax: 734-712-2820
Mailing address:
  • Phone: 734-434-6262
  • Fax: 734-712-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704195316
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: