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Individual
TIMOTHY DICKINSON
Active
Individual
TIMOTHY DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TD035680
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-30456
PHP PROV #
MI
01
—
0800307672
BCBS MI PROV #
MI
01
—
080069543
RAILROAD MEDICARE
MI
05
—
1276855
—
MI
01
—
15403
HEALTH PLAN OF MI
MI
01
—
1826150
UNITED HEALTHCARE
MI
01
—
5714
COMMUNITY CHOICE OF MI
MI
01
—
P00361393
RR MEDICARE
MI
01
—
P53504
BLUE CARE NETWORK
MI
01
—
TD035680
STATE LICENSE #
MI
Enumeration date
11/09/2005
Last updated
12/07/2011
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