MEDICARE: DR. TIMOTHY MOSS MD/PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SG0201X	Clinical Genetics (M.D.) Physician	4301501458	MI

General Provider Information

NPI Number	:	1568721850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MOSS MD/PHD

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE # MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 2000
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2526
Country	:	US
Telephone Number	:	616-391-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	04/23/2024

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