Individual
AUSTIN TYLER QUALIZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
601 GATEWAY BLVD N, CHESTERTON, IN 46304-9658
(219) 921-1444
(219) 921-5303
Mailing address
601 GATEWAY BLVD N, CHESTERTON, IN 46304-9658
(219) 921-1444
(219) 250-5256
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10003133
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300046175
—
IN
Enumeration date
10/19/2020
Last updated
05/20/2025
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