Active NPI
Joseph Timoshenko Oettinger, MD
- Obstetrics & Gynecology Physician
- Grand Rapids, MI
National Provider Identifier
1144303272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 4301030986
- Practice address
- 2000 Burton St SE
Grand Rapids, MI 49506-4670 - Phone
- (616) 245-2401
- Fax
- (616) 245-4052
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 4301030986 | MI | Primary |
Addresses
Primary practice location
2000 Burton St SE
Grand Rapids, MI 49506-4670
Mailing address
2000 Burton Rd SE
Grand Rapids, MI 49506
Phone (616) 245-2401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1168482 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301030986 | MI | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144303272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 BURTON RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49506",
"telephone_number": "616-245-2401",
"fax_number": "616-245-4052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BURTON ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495064670",
"telephone_number": "616-245-2401",
"fax_number": "616-245-4052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OETTINGER",
"first_name": "JOSEPH",
"middle_name": "TIMOSHENKO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MI",
"license": "4301030986",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1168482",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.