Provider Demographics
NPI:1598154825
Name:REEMS, TYLER DANIEL
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:DANIEL
Last Name:REEMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 S COPPER BEECH WAY APT E
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5242
Mailing Address - Country:US
Mailing Address - Phone:812-606-8993
Mailing Address - Fax:
Practice Address - Street 1:935 S COPPER BEECH WAY APT E
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5242
Practice Address - Country:US
Practice Address - Phone:812-606-8993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program