Provider Demographics
NPI:1790394641
Name:WILKE, TYLER (PA-C)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:WILKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 E GALBRAITH RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6705
Mailing Address - Country:US
Mailing Address - Phone:513-984-6444
Mailing Address - Fax:513-345-2606
Practice Address - Street 1:4750 E GALBRAITH RD STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6705
Practice Address - Country:US
Practice Address - Phone:513-984-6444
Practice Address - Fax:513-345-2606
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003443A208VP0014X, 363A00000X
OH50.006846RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine