Individual
TYLER DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
802 E GORHAM ST, MADISON, WI 53703-1524
(608) 445-3275
Mailing address
25 KESSEL CT STE 105, MADISON, WI 53711-6227
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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