1730793282 NPI number — MR. TYLER MICHAEL KEES I MS, LAC

Table of content: MR. TYLER MICHAEL KEES I MS, LAC (NPI 1730793282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730793282 NPI number — MR. TYLER MICHAEL KEES I MS, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEES
Provider First Name:
TYLER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
MS, LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730793282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1485 S COLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85296-8233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-282-3872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1730 E MCNAIR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-999-2590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LAC-19156 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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