Provider Demographics
NPI:1699759472
Name:BIEREMA, TIMOTHY A (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:BIEREMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 PLUM CREEK CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2153
Mailing Address - Country:US
Mailing Address - Phone:248-761-8782
Mailing Address - Fax:
Practice Address - Street 1:2560 PLUM CREEK CT
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MI
Practice Address - Zip Code:48363-2153
Practice Address - Country:US
Practice Address - Phone:248-761-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404762208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2779367Medicaid
MI16997759472Medicaid
MI2779367Medicaid
N97270001Medicare ID - Type Unspecified
MI16997759472Medicaid