Healthcare Provider Details

I. General information

NPI: 1255969325
Provider Name (Legal Business Name): STEVEN TYLER OHNMACHT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 10-5550 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

1620 N WILMOT RD UNIT P181
TUCSON AZ
85712-4480
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4661
  • Fax: 505-272-4628
Mailing address:
  • Phone: 480-313-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: