Individual
TYLER J VAN DE VOORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3526
(920) 433-0111
Mailing address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3575
(920) 433-0111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
81984-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100250432
—
WI
01
—
81984-20
WISCONSIN MEDICAL LICENSE
WI
Enumeration date
06/21/2017
Last updated
01/18/2024
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