Provider Demographics
NPI:1770517120
Name:JARVI, TIMOTHY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:JARVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 SUMMIT PARK DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8685
Mailing Address - Country:US
Mailing Address - Phone:231-348-3600
Mailing Address - Fax:231-348-3677
Practice Address - Street 1:2325 SUMMIT PARK DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8685
Practice Address - Country:US
Practice Address - Phone:231-348-3600
Practice Address - Fax:231-348-3677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301960047207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1802400811OtherBCBS MICHIGAN
MI4441872Medicaid
MI0N58850Medicare ID - Type UnspecifiedMEDICARE
MI4441872Medicaid
MI1802400811OtherBCBS MICHIGAN