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General NPI Number Information
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NPI Number | 1760352769
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Entity Type | Individual
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Provider Name | TIMOTHY FAASSE
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Gender | Male
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 961 4 MILE RD NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-8252
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Country | US
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Telephone | 616-784-6299
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Fax |
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Provider Business Mailing Address
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Address Line | 3281 WOODWIND DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9751
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Country | US
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Telephone | 616-666-2929
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Fax |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3502013324
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License Number State | MI
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