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General NPI Number Information
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NPI Number | 1922461235
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Entity Type | Individual
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Provider Name | TYLER DRAKE MENGE MD
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Gender | Male
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Dates
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Enumeration Date | 04/04/2016
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 3131 S STATE ST STE 309
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City | ANN ARBOR
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State | MI
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Zip | 48108-1658
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Country | US
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Telephone | 503-906-7300
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Fax | 503-245-8219
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Provider Business Mailing Address
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Address Line | PO BOX 230457
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City | PORTLAND
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State | OR
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Zip | 97281-0457
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Country | US
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Telephone | 503-906-7300
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35.139934
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301501739
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | MD203405
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) Physician
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License Number | 4301501739
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License Number State | MI
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