Individual
MR. TYLER K JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 WATER ST, EXCELSIOR, MN 55331-3072
(952) 906-7855
Mailing address
676 N SAINT CLAIR ST, SUITE 1600, CHICAGO, IL 60611-2927
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085005949
IL
Other
Enumeration date
08/31/2016
Last updated
05/07/2019
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