Healthcare Provider Details

I. General information

NPI: 1053248559
Provider Name (Legal Business Name): TYLER PAUL SIGNORELLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 WILSON RD RM A233
EAST LANSING MI
48824-6410
US

IV. Provider business mailing address

994 VINEYARD LN
AURORA IL
60502-8502
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-4362
  • Fax:
Mailing address:
  • Phone: 630-408-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5151018089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: