MEDICARE: TYIA MIDDLETON

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	363A00000X	Physician Assistant	50.010120RX	OH

General Provider Information

NPI Number	:	1427916337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYIA MIDDLETON

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	901-849-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	14600 DETROIT AVE APT 1218
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4229
Country	:	US
Telephone Number	:	901-849-4286
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	05/06/2026

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Directions to “ TYIA MIDDLETON ” Practice Location

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