Healthcare Provider Details

I. General information

NPI: 1750644233
Provider Name (Legal Business Name): TYLER YAPP D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2333
US

IV. Provider business mailing address

3042 W WELLINGTON AVE APT 2
CHICAGO IL
60618-6924
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2000
  • Fax:
Mailing address:
  • Phone: 608-219-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number135000770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: