Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 5101011807 | MI |
Y | 207RH0002X | Hospice and Palliative Medicine | 5101011807 | MI |
NPI | 1053399659 |
---|---|
Provider Name | Dr. Timothy James Fife |
First Address | Grand Rapids, MI 49503-1455 |
Second Address | Grand Rapids, MI 49503-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30927 | (02) |