Individual
MR. MICHAEL TODD TYSON X
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
696 WOODBINE AVE, ROCHESTER, NY 14619-2030
(585) 532-0636
Mailing address
696 WOODBINE AVE, ROCHESTER, NY 14619-2030
(585) 532-0636
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
760970342
NY
Other
Enumeration date
07/21/2017
Last updated
07/21/2022
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