Individual
TYLER WISHAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 GOOD SAMARITAN WAY STE 420, MOUNT VERNON, IL 62864-2478
(618) 899-3900
Mailing address
PO BOX 955860, SAINT LOUIS, MO 63195-2588
(636) 498-5944
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016005806
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005806
IL
Other
Enumeration date
04/09/2014
Last updated
02/22/2022
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