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General NPI Number Information
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NPI Number | 1972345304
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Entity Type | Individual
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Provider Name | TYLER LINDVALL DO
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Gender | Male
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 611 W PARK ST # A
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City | URBANA
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State | IL
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Zip | 61801-2501
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Country | US
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Telephone | 217-383-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 STONEWAY CT # A
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City | CHAMPAIGN
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State | IL
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Zip | 61822-2405
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Country | US
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Telephone | 847-946-0642
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125.084190
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License Number State | IL
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