Provider Demographics
NPI:1588417414
Name:NOLAN, TYLER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSEPH
Last Name:NOLAN
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 1:14601 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4205
Mailing Address - Country:US
Mailing Address - Phone:216-237-5500
Mailing Address - Fax:909-247-3326
Practice Address - Street 1:14601 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4205
Practice Address - Country:US
Practice Address - Phone:216-237-5500
Practice Address - Fax:909-247-3326
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program