Tyler Koerth, ATC
Individual provider Active NPI Sports Medicine (Emergency Medicine) Physician · Delton, MI
NPI 1578089645 · NPPES record last updated Aug 20, 2017
Key facts
- NPI
- 1578089645
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Emergency Medicine) Physician 207PS0010X
- License
- 2601001854 (MI)
- Practice address
- 10425 Panther Pride
Delton, MI 49046-8825 - Phone
- (269) 623-1520
- NPI assigned
- Aug 20, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601001854 | MI | MD | Sports Medicine (Emergency Medicine) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Emergency Medicine) Physician | 207PS0010X | 2601001854 | MI | Yes |
Addresses
Primary practice location
10425 Panther Pride
Delton, MI 49046-8825
Mailing address
4014 Ternwood Dr Apt 1a
Kalamazoo, MI 49048-6674
Other providers in Delton, MI
- Delton Family Pharmacy Inc
- Lyndsay Elyse Eckhart
- Sallie Mae Emert
- JCR DO PLC
- John D Kehl
- Logan Dakota Lockridge
- Mary A Martin
- Deborah Lynn Pace
- Pennock Hospital
- Pennock Hospital Board of Trustees
All providers in Delton, MI · Sports Medicine (Emergency Medicine) Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.