Healthcare Provider Details

I. General information

NPI: 1407476971
Provider Name (Legal Business Name): TYLER MASTERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

IV. Provider business mailing address

31201 CHICAGO R STE C301
WARREN MI
48093
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-6880
  • Fax: 586-573-2562
Mailing address:
  • Phone: 586-582-0864
  • Fax: 586-573-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number4351046615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: