Healthcare Provider Details

I. General information

NPI: 1720640030
Provider Name (Legal Business Name): TYLER JAMES LOUVIERE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 RICKERT DR STE 101
NAPERVILLE IL
60540-8904
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1971
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-1872
  • Fax: 630-355-3273
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-008020
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: