MEDICARE: TYLER SHEAR ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1275023335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER SHEAR ATC

Provider Business Mailing Address
First Line	:	2330 SAVOY ST NE
Second Line	:
City	:	BELMONT
State	:	MI
Zip	:	49306-9705
Country	:	US
Telephone Number	:	616-890-2851
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 MARYLAND AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6052
Country	:	US
Telephone Number	:	616-890-2851
Fax Number	:

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

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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