MEDICARE: DR. MICHAEL TIMINS MD

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	2085R0202X	Diagnostic Radiology Physician	32158	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	300040353	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	002000136V	OTHER	HUMANA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851342505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TIMINS MD

Provider Business Mailing Address
First Line	:	PO BOX 772555
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-2555
Country	:	US
Telephone Number	:	314-238-5260
Fax Number	:	314-821-1833

Provider Business Practice Location Address
First Line	:	350 S GREENLEAF ST STE 401
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-5709
Country	:	US
Telephone Number	:	314-238-5260
Fax Number	:	314-821-1833

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/09/2022

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