MEDICARE: TYLER K STEVENS M.D.

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	207R00000X	Internal Medicine Physician	35-081031	OH
2	207RG0100X	Gastroenterology Physician	81031	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000332717	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1114904729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER K STEVENS M.D.

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # A31
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-445-1996
Fax Number	:	216-444-6284

Provider Business Practice Location Address
First Line	:	4095 MEADOWBROOK BLVD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3854
Country	:	US
Telephone Number	:	216-371-4171
Fax Number	:

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	06/13/2011

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