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General NPI Number Information
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NPI Number | 1750348371
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Entity Type | Individual
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Provider Name | MIKE O TYLER JR. MD,
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 9565 HIGHWAY 78 BLDG 100
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City | LADSON
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State | SC
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Zip | 29456-4118
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Country | US
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Telephone | 843-553-7615
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Fax | 843-553-1008
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Provider Business Mailing Address
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Address Line | 9565 HIGHWAY 78 BLDG 100
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City | LADSON
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State | SC
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Zip | 29456-4118
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Country | US
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Telephone | 843-553-7615
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Fax | 843-553-1008
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 8587
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License Number State | SC
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