Johnson, Tyler Guthrie
Johnson, Tyler Guthrie is an individual health care provider with primary practice located at 2200 Randallia Dr , Fort Wayne IN 46805-4638. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Johnson, Tyler Guthrie can be contacted via phone (260) 373-4000.Contact Information
Primary practice address
2200 Randallia Dr
Fort Wayne IN 46805-4638
Phone: (260) 373-4000
Fax: (260) 482-4442
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 5101018131 | Michigan |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 02003913A | Indiana |
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | 5101018131 | Michigan |
Profile Details
| NPI number | 1578798757 |
|---|---|
| LBN Legal business name | Johnson, Tyler Guthrie |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 18th, 2009 |
| Last updated | Mar 16th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578798757 | NPPES |
| Indiana | Other | M400058749 | MEDICARE WPS CMS |
| Indiana | MEDICAID | 201040270 | MEDICARE WPS CMS |
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