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NPI Code Detail

MEDICARE: MR. TYLER KING

MEDICARE: MR. TYLER KING
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1184387037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYLER KING
Provider Business Mailing Address
First Line : 7300 SCHEY DR
Second Line :
City : EDINA
State : MN
Zip : 55439-1756
Country : US
Telephone Number : 612-807-5522
Fax Number :
Provider Business Practice Location Address
First Line : 2000 UNIVERSITY AVE
Second Line :
City : DUBUQUE
State : IA
Zip : 52001-5099
Country : US
Telephone Number : 563-589-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 10/18/2021

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Directions to “ MR. TYLER KING ” Practice Location

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