NPIMap

Individual provider Active NPI

Tyler Conway, MD

  • Dermatology Physician
  • Marlette, MI
National Provider Identifier
1104269000
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
4301515313 Issued in MI
Practice address
2985 Main St
Marlette, MI 48453-1112
Phone
(989) 912-6850
Fax
(989) 912-6080
NPI assigned
Apr 10, 2013
Last updated
Jun 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 62134 MN
Dermatology Physician 207N00000X 4301515313 MI Primary
Dermatology Physician 207N00000X 036.147026 IL

Addresses

Primary practice location

2985 Main St
Marlette, MI 48453-1112

Mailing address

2985 Main St
Marlette, MI 48453-1112
Phone (989) 635-4043

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180913000286 IL Practitioner - Dermatology 2769704451 Reassigns benefits to 2 organizations
I20260504005554 MI Practitioner - Dermatology 2769704451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Minnesota Medical School, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CGH Medical CenterGroup PAC ID 6103723267, 199 clinicians
Suleman J. Bangash D.O.S.C.Group PAC ID 8729165006, 17 clinicians
Marlette Regional HospitalGroup PAC ID 3971408121, 32 clinicians

Practice addresses (Care Compare)

101 E Miller Rd
Sterling, IL 61081-1252
Phone (815) 625-4790

1750 N Randall Rd
Suite 120
Elgin, IL 60123-7900
Phone (847) 608-6647

4000 Huron St
North Branch, MI 48461-8664
Phone (810) 688-3048

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision48
Removal of skin lesions698
Removal of skin cancer1-10
Removal of nail tissue1-10
Removal or shaving of skin growth29
Skin biopsy253

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.147026ILMDDermatology Physician
4301515313MIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CGH Medical Center CurrentSince Jul 1, 2024 Accepting new patients
CGH Medical Center CurrentSince Jul 1, 2024 Accepting new patients
Suleman J. Bangash D.O.S.C. CurrentSince Aug 6, 2018 Accepting new patients
CGH Medical Center Current Accepting new patients
Mohs Surgery &Dermatology PastSince Aug 6, 2018 Accepting new patients
Elk Grove Dermatology, S.C. Dermatology Past Accepting new patients
TLC Medical Group, S.C. Past Accepting new patients

Locations

820 E Terra Cotta Ave
Ste 125
Crystal Lake, IL 60014
Phone (815) 455-4434

1750 N Randall Rd
Ste 120
Elgin, IL 60123
Phone (847) 608-6647

901 Biesterfield Rd
Ste 209
Elk Grove Vlg, IL 60007
Phone (847) 593-6222

10370 Haligus Rd
Ste 109
Huntley, IL 60142
Phone (815) 356-0500

214 Washington St
Ste 6
Ingleside, IL 60041
Phone (773) 267-0554

40W222 Lafox Rd
Ste J1
St Charles, IL 60175
Phone (630) 513-9160

101 E Miller Rd
Sterling, IL 61081
Phone (815) 632-5285

Interoperability endpoints

  • Direct secure messaging: tconway@directaddress.net
  • Direct secure messaging: tconway21295@cghmc.direct-ci.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1104269000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2985 MAIN ST",
            "city": "MARLETTE",
            "state": "MI",
            "postal_code": "484531112",
            "telephone_number": "989-635-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2985 MAIN ST",
            "city": "MARLETTE",
            "state": "MI",
            "postal_code": "484531112",
            "telephone_number": "989-912-6850",
            "fax_number": "989-912-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "TYLER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-10",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "62134",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301515313",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036.147026",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlette, MI

Sources for this page

Verify at the official NPI Registry.