Healthcare Provider Details

I. General information

NPI: 1780038851
Provider Name (Legal Business Name): TYLER QIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MINISTRY PKWY
WESTON WI
54476-5220
US

IV. Provider business mailing address

1550 E ROYALL PL UNIT 606
MILWAUKEE WI
53202-1871
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-1000
  • Fax:
Mailing address:
  • Phone: 847-609-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number70085
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: