Provider Demographics
NPI:1225831621
Name:VANDIJK, TYLER (MD, MSBME)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:VANDIJK
Suffix:
Gender:
Credentials:MD, MSBME
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:GRANT
Other - Last Name:VANDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 N MARIO CAPECCHI DR.
Mailing Address - Street 2:3RD FLOOR NORTH
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5888
Mailing Address - Country:US
Mailing Address - Phone:801-581-7606
Mailing Address - Fax:
Practice Address - Street 1:30 N MARIO CAPECCHI DR.
Practice Address - Street 2:3RD FLOOR NORTH
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-5888
Practice Address - Country:US
Practice Address - Phone:801-581-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program