Provider Demographics
NPI:1346324118
Name:TYLER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:TYLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 OLD GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5655
Mailing Address - Country:US
Mailing Address - Phone:919-542-2731
Mailing Address - Fax:919-542-7083
Practice Address - Street 1:75 OLD GRAHAM RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5655
Practice Address - Country:US
Practice Address - Phone:919-542-2731
Practice Address - Fax:919-542-7083
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC31985OtherMEDCOST-PITTSBORO
NC8984267Medicaid
NC0151838OtherUNITEDHEALTHCARE-SANFORD
NC0151836OtherUNITEDHEALTHCARE-PITTSBOR
152734500OtherUS DEPT. OF LABOR
NC84267OtherBCBS
NC51232OtherMEDCOST-SANFORD
NC080153048Medicare PIN
NC080065783Medicare PIN
152734500OtherUS DEPT. OF LABOR
NC0151836OtherUNITEDHEALTHCARE-PITTSBOR
NC8984267Medicaid