Provider Demographics
NPI:1760040034
Name:BAZIL, TIMOTHY (DO)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BAZIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30148
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2053
Mailing Address - Country:US
Mailing Address - Phone:248-900-1555
Mailing Address - Fax:248-516-5017
Practice Address - Street 1:34020 7 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3093
Practice Address - Country:US
Practice Address - Phone:248-900-1555
Practice Address - Fax:248-516-5017
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101028077207LP2900X
MI5151013516208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760040034Medicaid