Provider Demographics
NPI:1518317312
Name:MARKUS, TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:MARKUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S WELLS ST APT 1609
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4792
Mailing Address - Country:US
Mailing Address - Phone:561-901-6812
Mailing Address - Fax:
Practice Address - Street 1:17859 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3937
Practice Address - Country:US
Practice Address - Phone:708-532-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0306281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice