Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 5901001793 | MI |
NPI | 1023053436 |
---|---|
Provider Name | Timothy J Hulst |
First Address | Grand Rapids, MI 49546 |
Second Address | Grand Rapids, MI 49546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1266510003 | ADMINISTAR (01) | MI |
3506880 | (05) | MI |
480026384 | RAILROAD MEDICARE (01) | MI |