Healthcare Provider Details

I. General information

NPI: 1679100580
Provider Name (Legal Business Name): TYLER JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 BEECHMONT AVE STE K
CINCINNATI OH
45255-4231
US

IV. Provider business mailing address

7545 BEECHMONT AVE STE K
CINCINNATI OH
45255-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-564-4277
  • Fax: 513-564-4278
Mailing address:
  • Phone: 513-564-4277
  • Fax: 513-564-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.149115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: