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General NPI Number Information
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NPI Number | 1053399659
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES FIFE DO
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 1000 MONROE AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1455
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Country | US
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Telephone | 616-732-6200
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Fax | 616-732-6255
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Provider Business Mailing Address
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Address Line | 1000 MONROE AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1455
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Country | US
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Telephone | 616-732-6200
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Fax | 616-732-6255
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5101011807
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 5101011807
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License Number State | MI
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