Basic Information
| Provider Information | |||||||||
| NPI: | 1306227780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATLIFF | ||||||||
| FirstName: | TIM | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18700 N 64TH DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027268788 | ||||||||
| FaxNumber: | 4804200732 | ||||||||
| Practice Location | |||||||||
| Address1: | 18700 N 64TH DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027268788 | ||||||||
| FaxNumber: | 4804200732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 008041 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.