Healthcare Provider Details

I. General information

NPI: 1952535643
Provider Name (Legal Business Name): TIMOTHY WARREN MIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date: 11/17/2016
Reactivation Date: 07/23/2019

III. Provider practice location address

1959 NE PACIFIC ST CAMPUS BOX 356540
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC ST CAMPUS BOX 356540
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-468-0572
  • Fax:
Mailing address:
  • Phone: 206-543-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: