Healthcare Provider Details

I. General information

NPI: 1407210255
Provider Name (Legal Business Name): TYLER ERWIN NARLOCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NW BARSTOW ST SUITE 201
WAUKESHA WI
53188-3771
US

IV. Provider business mailing address

210 NW BARSTOW ST SUITE 201
WAUKESHA WI
53188-3771
US

V. Phone/Fax

Practice location:
  • Phone: 262-548-6903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67972
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: