Healthcare Provider Details

I. General information

NPI: 1235918004
Provider Name (Legal Business Name): TIMOTHY A SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 W 112TH ST
CLEVELAND OH
44102-1413
US

IV. Provider business mailing address

121 N LEAVITT RD # 311
AMHERST OH
44001-1100
US

V. Phone/Fax

Practice location:
  • Phone: 561-398-3409
  • Fax: 216-713-0034
Mailing address:
  • Phone: 561-398-3409
  • Fax: 216-713-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: