Tyler Koerth, ATC

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

2601001854 Issued in MI

Practice address

10425 Panther Pride
Delton, MI 49046-8825

Phone

(269) 623-1520

NPI assigned

Aug 20, 2017

Last updated

Aug 20, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1503187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503187200000",
    "number": "1578089645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4014 TERNWOOD DR APT 1A",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490486674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10425 PANTHER PRIDE",
            "city": "DELTON",
            "state": "MI",
            "postal_code": "490468825",
            "telephone_number": "269-623-1520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOERTH",
        "first_name": "TYLER",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-20",
        "last_updated": "2017-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "MI",
            "license": "2601001854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delton Family Pharmacy Inc (Delton Family Pharmacy)
• Lyndsay Elyse Eckhart, CBD
• Sallie Mae Emert
• JCR DO PLC (Delton Medical Center)
• John D Kehl, PA
• Logan Dakota Lockridge, PHARMD
• Mary A Martin, CNM
• Deborah Lynn Pace
• Pennock Hospital (CHPNH TM Clinic Delton Kellog)
• Pennock Hospital Board of Trustees

• Sports Medicine (Emergency Medicine) Physician in Delton, MI
• Providers in Delton, MI by specialty
• Sports Medicine (Emergency Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.