Individual
TYLER D LEIVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
231 E CHESTNUT ST, LOUISVILLE, KY 40202-1821
(502) 588-0390
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
60360
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2018
Last updated
07/17/2025
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