Healthcare Provider Details

I. General information

NPI: 1023874856
Provider Name (Legal Business Name): TYLER CARD HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 GEZON PKWY SW STE A
GRAND RAPIDS MI
49509-9564
US

IV. Provider business mailing address

901 GEZON PKWY SW STE A
GRAND RAPIDS MI
49509-9564
US

V. Phone/Fax

Practice location:
  • Phone: 616-530-8883
  • Fax: 616-530-8997
Mailing address:
  • Phone: 616-530-8883
  • Fax: 616-530-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501007517
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: