Provider Demographics
NPI:1235638263
Name:POPIL, TYLER JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:POPIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36100 EUCLID AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4427
Mailing Address - Country:US
Mailing Address - Phone:440-953-6294
Mailing Address - Fax:440-918-4687
Practice Address - Street 1:36100 EUCLID AVE STE 240
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4427
Practice Address - Country:US
Practice Address - Phone:440-953-6294
Practice Address - Fax:440-918-4687
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.005472RXOtherOHIO ELICENSURE OHIO PROFESSIONAL LICENSURE
OH0265766Medicaid
OH0265766OtherNCCPA