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NPI Code Detail

MEDICARE: TYLER M NEITLICH MD

MEDICARE: TYLER M NEITLICH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician16148ND
22085R0202XDiagnostic Radiology Physician12500CWY
32085R0202XDiagnostic Radiology PhysicianME99487FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME99487OTHERFLMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144429317
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER M NEITLICH MD
Provider Business Mailing Address
First Line : 17310 WRIGHT ST STE 103
Second Line :
City : OMAHA
State : NE
Zip : 68130-2405
Country : US
Telephone Number : 833-228-6889
Fax Number : 877-853-0376
Provider Business Practice Location Address
First Line : 100 E CAMPUS VIEW BLVD STE 100
Second Line :
City : COLUMBUS
State : OH
Zip : 43235-8628
Country : US
Telephone Number : 614-340-7740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2007
Last Update Date : 11/05/2024

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Directions to “ TYLER M NEITLICH MD” Practice Location

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