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NPI Code Detail

MEDICARE: TYLER JAMES PASCAVIS MD

MEDICARE: TYLER JAMES PASCAVIS MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramR78523AZ
2207Q00000XFamily Medicine Physician036170444IL

General Provider Information

NPI Number : 1558945618
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER JAMES PASCAVIS MD
Provider Business Mailing Address
First Line : 611 W PARK
Second Line : FAPC
City : URBANA
State : IL
Zip : 61802
Country : US
Telephone Number : 217-902-6954
Fax Number : 217-902-7711
Provider Business Practice Location Address
First Line : 1302 FRANKLIN AVE STE 1100
Second Line :
City : NORMAL
State : IL
Zip : 61761-0016
Country : US
Telephone Number : 309-268-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2021
Last Update Date : 12/18/2024

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