Individual
TYLER DANIEL WITHERSPOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 274-0275
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02005900A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001539141
ANTHEM PTAN
IN
01
—
1102450736
ANTHEM PTAN
IN
05
—
300004675
—
IN
01
—
Q00202325
RAILROAD PTAN
IN
Enumeration date
03/28/2017
Last updated
11/21/2024
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