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1780849620

NPI Code Detail

MEDICARE: TYLER J GREEN MD

MEDICARE: TYLER J GREEN 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	2085R0202X	Diagnostic Radiology Physician	04-40433	KS
2	2085R0202X	Diagnostic Radiology Physician	55471	CO
3	2085R0204X	Vascular & Interventional Radiology Physician	DR.0055471	CO
4	2085R0202X	Diagnostic Radiology Physician	MD19335	HI
5	2085R0202X	Diagnostic Radiology Physician	30330	NE
6	2085R0202X	Diagnostic Radiology Physician	MD166193	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA1215124	OTHER	NE	MEDICARE PIN
2	NA2517101	OTHER	NE	MEDICARE PIN
3	111257111	OTHER	KS	MEDICARE PIN
4	590453YQ3L	OTHER	CO	MEDICARE PIN
5	590453YQPG	OTHER	CO	MEDICARE PIN
7	NA1214123	OTHER	NE	MEDICARE PIN
8	590453YQ33	OTHER	CO	MEDICARE PIN
9	KA3249102	OTHER	KS	MEDICARE PIN
10	590453YQN9	OTHER	CO	MEDICARE PIN

Other Identifiers

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

General Provider Information

NPI Number	:	1780849620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER J GREEN MD

Provider Business Mailing Address
First Line	:	10800 E GEDDES AVE STE 300
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-3895
Country	:	US
Telephone Number	:	303-761-9190
Fax Number	:	720-874-4462

Provider Business Practice Location Address
First Line	:	10800 E GEDDES AVE STE 300
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-3895
Country	:	US
Telephone Number	:	303-761-9190
Fax Number	:	720-874-4462

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

Provider Enumeration Date	:	07/21/2008
Last Update Date	:	11/17/2023

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1831172378 — JEFFRY P WEINGARDT MD
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1922083401 — PHILLIP GUNTHER MD
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1184609513 — CRAIG C JONAS MD
Practice Location Address:

10800 E GEDDES AVE STE 300
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Directions to “ TYLER J GREEN MD” Practice Location

Language	Start Address	Practice Location

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