Provider Demographics
NPI:1689763104
Name:GRINDAL, TYLER CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CURTIS
Last Name:GRINDAL
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 1:920 SW LANE ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1543
Mailing Address - Country:US
Mailing Address - Phone:785-233-0500
Mailing Address - Fax:785-233-0660
Practice Address - Street 1:920 SW LANE ST
Practice Address - Street 2:SUITE #200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1543
Practice Address - Country:US
Practice Address - Phone:785-233-0500
Practice Address - Fax:785-233-0660
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN8992207Y00000X
KS04-34310207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200663420AMedicaid
KS200663420AMedicaid