MEDICARE: VELMA TYCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1073061958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VELMA TYCE

Provider Business Mailing Address
First Line	:	517 LIBERTY ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3138
Country	:	US
Telephone Number	:	574-383-7072
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 LIBERTY ST
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46619-3138
Country	:	US
Telephone Number	:	574-383-7072
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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Directions to “ VELMA TYCE ” Practice Location

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