Healthcare Provider Details

I. General information

NPI: 1154421907
Provider Name (Legal Business Name): TIMOTHY C GEIL LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18021 15TH AVE NE
SHORELINE WA
98155
US

IV. Provider business mailing address

PO BOX 55267
SHORELINE WA
98155-0267
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-0110
  • Fax: 206-365-1920
Mailing address:
  • Phone: 206-365-0110
  • Fax: 206-365-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberMA7485
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: