Individual
DYLLAN TIBURZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2235 CLEVELAND RD, SOUTH BEND, IN 46628-3529
(574) 647-4530
(574) 647-2285
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01085663A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300014050
—
IN
Enumeration date
04/27/2018
Last updated
10/09/2023
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