Individual
MICHAEL C TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
65 N MEDICAL DR, SALT LAKE CITY, UT 84132-1000
(801) 585-6526
Mailing address
65 N MEDICAL DR, SALT LAKE CITY, UT 84132-1000
(801) 585-6526
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
178754-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107001187102
IHC
UT
01
—
28749
PEHP
UT
01
—
293655
DMBA
UT
01
—
870542403 84121 A002
TRICARE
UT
01
—
93863
GEM
UT
01
—
PRA01321
MOLINA
UT
01
—
QMXAF01875
ALTIUS
UT
Enumeration date
10/02/2006
Last updated
08/02/2007
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