Healthcare Provider Details

I. General information

NPI: 1144429317
Provider Name (Legal Business Name): TYLER M NEITLICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 W UNDERWOOD ST
ORLANDO FL
32806
US

IV. Provider business mailing address

52 W UNDERWOOD ST MP 153
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3900
  • Fax:
Mailing address:
  • Phone: 321-841-2558
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12500C
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME99487
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number16148
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: