Individual
DR. MICHAEL ROBERT TISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 CHAPEL DR, GRANVILLE, OH 43023-6504
(740) 587-6200
(740) 587-6758
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(740) 587-6200
(740) 587-6758
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35.122274
OH
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
35.122274
OH
207PS0010X
Sports Medicine (Emergency Medicine) Physician
35.122274
OH
207R00000X
Internal Medicine Physician
Primary
35.122274
OH
207RS0010X
Sports Medicine (Internal Medicine) Physician
35.122274
OH
Other
Enumeration date
05/08/2011
Last updated
04/08/2026
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