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General NPI Number Information
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NPI Number | 1306112669
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Entity Type | Individual
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Provider Name | MICHAEL TYLER KING MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3600 W BETHEL AVE
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City | MUNCIE
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State | IN
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Zip | 47304-5407
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Country | US
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Telephone | 800-622-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A126418
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01077058A
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License Number State | IN
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