Individual
TYLER WILSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 W WHITE OAKS DR, SPRINGFIELD, IL 62704-6423
(217) 698-8153
Mailing address
119 W GREEN ST, VIRDEN, IL 62690-1319
(815) 883-1259
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
3388
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3388
ILLINOIS DEPARTMENT OF PUBLIC HEALTH- HEARING INSTRUMENT DISPENSER
IL
Enumeration date
05/30/2019
Last updated
06/21/2023
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