Most Relevant Information
Provider Data
| NPI Number: | 1003362914 |
| Provider Name: | TYLER K JOHNSON PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 085005949 |
Most Important Dates
| Enumeration Date: | 08/31/2016 |
| Last Updated: | 05/07/2019 |
Provider Practice Location
675 WATER ST
EXCELSIOR
MN
553313072
Practice Location Phone/Fax
| Phone: | 9529067855 |
| Fax: |
Provider Mailing Location
676 N SAINT CLAIR ST
SUITE 1600
CHICAGO
IL
606112927
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |