Healthcare Provider Details

I. General information

NPI: 1902338320
Provider Name (Legal Business Name): TYLER DANIEL MCKEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WE KNIGHT DR
FORT SMITH AR
72903-6254
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6700
  • Fax: 479-709-6710
Mailing address:
  • Phone: 314-543-6979
  • Fax: 314-364-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001333A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001333A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number306
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: