Provider Demographics
NPI:1447850011
Name:MATTHEWS, TIMOTHY (RDN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5057 JEDDO RD
Mailing Address - Street 2:
Mailing Address - City:GRANT TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48032-1402
Mailing Address - Country:US
Mailing Address - Phone:810-300-1268
Mailing Address - Fax:
Practice Address - Street 1:5057 JEDDO RD
Practice Address - Street 2:
Practice Address - City:GRANT TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48032-1402
Practice Address - Country:US
Practice Address - Phone:810-300-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered