Healthcare Provider Details

I. General information

NPI: 1871024331
Provider Name (Legal Business Name): TIMOTHY BIKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 03/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7010
  • Fax: 401-736-1975
Mailing address:
  • Phone: 401-737-7010
  • Fax: 401-736-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number111
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: