Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 01086221A | IN |
N | 207T00000X | Neurosurgeon | 201649 | NC |
NPI | 1114331493 |
---|---|
Provider Name | Tyler Atkins |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 09/08/2021 |