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1720071012

NPI Code Detail

MEDICARE: JAMES M TYTKO MD

MEDICARE: JAMES M TYTKO 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
1	207QS0010X	Sports Medicine (Family Medicine) Physician	35046245	OH
2	207Q00000X	Family Medicine Physician	35046245	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080152126	OTHER	OH	MEDICARE RR

Other Identifiers

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

General Provider Information

NPI Number	:	1720071012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M TYTKO MD

Provider Business Mailing Address
First Line	:	2145 N FAIRFIELD RD STE 100
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-2783
Country	:	US
Telephone Number	:	937-558-3900
Fax Number	:	937-558-3999

Provider Business Practice Location Address
First Line	:	2145 N FAIRFIELD RD STE 100
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-2783
Country	:	US
Telephone Number	:	937-558-3900
Fax Number	:	937-558-3999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/17/2020

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Directions to “ JAMES M TYTKO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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