Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 4301503867 | MI |
Y | 207RI0011X | Interventional Cardiology | 4301503867 | MI |
NPI | 1013328236 |
---|---|
Provider Name | Timothy Andrew Joseph |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49525-6427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2014 |
Last Update Date | 02/08/2021 |