Individual
TIMOTHY GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
31330 SCHOOLCRAFT RD, STE 200, LIVONIA, MI 48150-2041
(734) 525-9712
Mailing address
31330 SCHOOLCRAFT RD, STE 200, LIVONIA, MI 48150-2041
(734) 525-9712
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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