Provider Demographics
NPI:1447223045
Name:TYRE, TIMOTHY E (PHD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:TYRE
Suffix:
Gender:M
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:WAUKESHA MEMORIAL HOSPITAL-NEUROSCIENCE CENTER
Practice Address - Street 2:725 AMERICAN AVENUE
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-928-8200
Practice Address - Fax:262-928-8699
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI508103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39065100Medicaid
WI683750661Medicare PIN
WI002568280Medicare PIN
WIR39421Medicare UPIN