Provider Demographics
NPI:1063705135
Name:AN, TYLER INCHUL (DO)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:INCHUL
Last Name:AN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3005
Mailing Address - Country:US
Mailing Address - Phone:404-446-0600
Mailing Address - Fax:404-446-0601
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL RD
Practice Address - Street 2:SUITE 290
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3005
Practice Address - Country:US
Practice Address - Phone:404-446-0600
Practice Address - Fax:404-446-0601
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019313207R00000X
GA79573207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM77890508Medicare PIN