Healthcare Provider Details

I. General information

NPI: 1013544287
Provider Name (Legal Business Name): TYLER BISCHOF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK WEST BLVD
AKRON OH
44320-4218
US

IV. Provider business mailing address

1 PARK WEST BLVD
AKRON OH
44320-4218
US

V. Phone/Fax

Practice location:
  • Phone: 330-835-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number34.015759
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: