Healthcare Provider Details

I. General information

NPI: 1811524101
Provider Name (Legal Business Name): TYLER MICHAEL SPIVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 5018
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE, LOCATION E FLOOR 4 MLC 5018
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4315
  • Fax: 513-636-4991
Mailing address:
  • Phone: 513-636-4315
  • Fax: 513-636-4991

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: