Timothy C St. John II

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

TIMOTHY C ST. JOHN II

Doing business as

Houghton Lake Foot Clinic

Practice address

3179 W Houghton Lake Dr
Houghton Lake, MI 48629-9256

Phone

(989) 366-8332

NPI assigned

Dec 24, 2005

Reactivated

Jan 24, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Timothy St John, DPM

Title

President

Phone

(989) 366-8332

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Houghton Lake Foot Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1780661322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 LEONARD ST NW",
            "address_2": "SUITE 103",
            "city": "WALKER",
            "state": "MI",
            "postal_code": "495348447",
            "telephone_number": "616-453-6329",
            "fax_number": "616-453-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3179 W HOUGHTON LAKE DR",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299256",
            "telephone_number": "989-366-8332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY C ST. JOHN II",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-24",
        "last_updated": "2010-01-04",
        "deactivation_date": "2008-01-03",
        "reactivation_date": "2008-01-24",
        "status": "A",
        "authorized_official_last_name": "ST JOHN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-366-8332",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3119585",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Houghton Lake Foot Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Podiatrist in Houghton Lake, MI
• Providers in Houghton Lake, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.