Provider Demographics
NPI:1073620993
Name:LEWARK, TYLER M (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:M
Last Name:LEWARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-750-8600
Mailing Address - Fax:303-743-7800
Practice Address - Street 1:1400 S POTOMAC ST
Practice Address - Street 2:SUITE 240
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4528
Practice Address - Country:US
Practice Address - Phone:303-750-8600
Practice Address - Fax:303-743-7800
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO36897207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08580821Medicaid
WY1073620993Medicaid
CO12105864Medicaid
CO12105864Medicaid
CO36897Medicare PIN
H43862Medicare UPIN
WY1073620993Medicaid