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General NPI Number Information
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NPI Number | 1205494994
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Entity Type | Individual
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Provider Name | TYLER ROBERT PETREE DO
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 313-966-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 3816 PINE VALLEY DR
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City | PLANO
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State | TX
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Zip | 75025-2062
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Country | US
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Telephone | 214-675-0240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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