Healthcare Provider Details

I. General information

NPI: 1770225369
Provider Name (Legal Business Name): TYLER JONAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

2 PLOVER CIR
MADISON WI
53717-1828
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82210-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: