# TIMOTHY D FAGEN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750315958
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 2010014000 | MO | Yes |
| 208D00000X | General Practice Physician | 5101017047 | MI | — |
| 208D00000X | General Practice Physician | DOS 1120 | HI | — |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 08/11/2010