Provider Demographics
NPI:1831815737
Name:MCNIEL, TIMOTHY (CSFA)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MCNIEL
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-1415
Mailing Address - Country:US
Mailing Address - Phone:810-513-1188
Mailing Address - Fax:
Practice Address - Street 1:3536 HIGHWAY 6 # 150
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4401
Practice Address - Country:US
Practice Address - Phone:810-513-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI173378246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant