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General NPI Number Information
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NPI Number | 1982911558
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Entity Type | Individual
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Provider Name | TIMESHA YOUNG PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 41000 WOODWARD AVE
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48304-5130
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Country | US
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Telephone | 248-593-6990
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Fax | 248-593-5130
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST
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City | ANN ARBOR
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State | MI
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Zip | 48108-1633
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Country | US
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Telephone | 734-647-5299
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4682
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601010148
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License Number State | MI
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