Individual
MR. LAWRENCE R TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1815 HENSON AVE, KALAMAZOO, MI 49048-1510
(269) 492-6500
(269) 492-6461
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-1400
(239) 424-1421
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
50-00-0236
OH
363AS0400X
Surgical Physician Assistant
Primary
5601007215
MI
363AS0400X
Surgical Physician Assistant
PA9108308
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447299789
—
MI
Enumeration date
06/05/2006
Last updated
03/30/2020
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