Healthcare Provider Details

I. General information

NPI: 1982220760
Provider Name (Legal Business Name): TYLER EDMUND RYMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

IV. Provider business mailing address

1266 WALTON BLVD
ROCHESTER HILLS MI
48307-6900
US

V. Phone/Fax

Practice location:
  • Phone: 248-710-2900
  • Fax: 248-710-2905
Mailing address:
  • Phone: 248-710-2900
  • Fax: 248-710-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061777
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: