Individual
TYLER JOSEPH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1120 MAIN ST, UNION GROVE, WI 53182-1328
(262) 878-4424
Mailing address
1911 N EMMERTSEN RD, MOUNT PLEASANT, WI 53406-2613
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
8089-23
WI
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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