Provider Demographics
NPI:1942534581
Name:TYLER, CHAD P (DO)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:P
Last Name:TYLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1234
Mailing Address - Country:US
Mailing Address - Phone:716-332-4476
Mailing Address - Fax:
Practice Address - Street 1:1491 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14217-1234
Practice Address - Country:US
Practice Address - Phone:716-332-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259454-1207Q00000X
MI5101017951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine