Provider Demographics
NPI:1952523482
Name:LEIGH, TYLER T (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:T
Last Name:LEIGH
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:583 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5515
Practice Address - Country:US
Practice Address - Phone:812-676-4460
Practice Address - Fax:812-355-4092
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI601242084N0400X
NY2486502084N0400X
IN01076511A2084S0012X, 2084N0400X
MT20122207T00000X
CAC140760207T00000X, 2084N0400X
WY10053A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery