Doctor Name: | TIMOTHY BLAIR CHIRDON |
NPI Number: | 1023308160 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | |
Business Practice Address: | 17527 Madison Ave Apt 206 Lakewood, OH - 441073579 |
Business Phone Number: | 4409412634 |
Business Fax Number: | |
Mailing Address: | 26908 Detroit Rd, Ste 201 WESTLAKE |
State: | OH |
Postal Code: | 441452398 |
Phone Number: | 4407773500 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2011 |
NPI Last Update Date: | 11/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |