TYLER WISHAU


Address: 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478
Phone: 6188993900

TYLER WISHAU (NPI# 1144649856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144649856
Entity Type Individual
Full Name TYLER WISHAU
Practice Address 2 Good Samaritan Way Ste 420
Mount Vernon
IL 62864-2478
Mailing Address Po Box 955860
Saint Louis
MO 63195-2588
Practice Telephone 6188993900
Mailing Telephone 6364985944
Enumeration Date 2014-04-09
Last Update Date 2020-10-22
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 213E00000X Podiatrist 016005806 IL Podiatric Medicine & Surgery Service Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
12303 Depaul Dr., Bridgeton, MO 630442588 3143446000

Office Location

Street Address 2 GOOD SAMARITAN WAY STE 420
City MOUNT VERNON
State IL
Zip Code 62864-2478

Providers in the same location

NPI Name Taxonomy Address Enumeration
1841268521 Gregory Szych Internal Medicine 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2006-03-09
1295192805 Tamara Copeland Nurse Practitioner 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2016-01-27
1215311683 Chandra Kanth Chaturvedula Internal Medicine 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2015-07-16
1194022541 Faizan Ali Khan Internal Medicine 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2011-02-22
1689810855 Marc Louis Sabatino Physical Medicine & Rehabilitation 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2008-12-18
1396919544 Naga Srinivas Sirikonda Internal Medicine 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2008-04-18
1437210341 Richard Chernecky Internal Medicine 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2006-12-13
1649280793 Louis Clarence Remynse IIi Urology 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2006-08-09
1841239316 Michelle Burwell Physician Assistant 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 2006-06-06

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619438892 Melissa Pryer Dietitian, Registered 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 2019-03-28
1487145454 Chiropractic Wellness Center of Mt Vernon, LLC. Chiropractor 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 2018-05-24
1851889208 Kimberly Tate Counselor 4110 North Water Place, Mt. Vernon, IL 62864 2018-05-01
1871907790 University Hematology Oncology Inc Specialist #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 2014-06-18
1457771677 Dynamic Counseling and Consultation Services Social Worker 3600 S Water Tower Pl, Mt Vernon, IL 62864 2014-04-27
1619239431 Judith C Morgan Counselor 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 2012-06-08
1073888624 James Brian Verges Counselor 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 2012-03-15
1720352271 Lucinda M. Holdren Counselor 16338 North Illinois Highway 37, Mount Vernon, IL 62864 2012-03-01
1780978627 Jamie M Orange Physical Therapy Assistant 19958 Fairfield Rd, Mt. Vernon, IL 62864 2011-06-08
1780978791 Wendy Marie Claytor Speech-Language Pathologist 600 E Il Hwy 15, Mount Vernon, IL 62864 2011-06-07
Find all providers in zip 62864

Taxonomy Information

Taxonomy Code 213E00000X
Grouping Podiatric Medicine & Surgery Service Providers
Classification Podiatrist

Taxonomy Definition

A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1598996043 Dorinda Amun King-adekunle Podiatrist 9 Harrison Street, Mount Vernon, NY 10550-3611 2009-07-31
1588725709 Anthony Dimarino Podiatrist 319 N 7th Ave, Mount Vernon, NY 10550-1792 2006-12-12
1649293846 Michael Fracassa Podiatrist 812 Coshocton, Mount Vernon, OH 43050 2006-07-26
1407827454 Randolph Verity Anderson Podiatrist 120 S 15th St, Suite 2, Mount Vernon, WA 98274-4500 2006-01-29
1427049535 Jonathan M Knee Podiatrist 514 Gramatan Ave, P4, Mount Vernon, NY 10552-3054 2005-10-31
1659369155 Robert A Atwell Podiatrist 809 Coshocton Ave, Suite A, Mount Vernon, OH 43050-1900 2005-10-10
1437698842 S Thomas Sehy Dpm LLC Podiatrist 209 Crossroads Pl, Suite 130, Mount Vernon, IL 62864-6545 2017-02-17
1104205103 Dae Yong Lee Podiatrist 12 N 7th Ave, Mount Vernon, NY 10550-2026 2015-05-22
1568777175 Nathan Allen Ullom Podiatrist 1400 E Kincaid St, Mount Vernon, WA 98274-4127 2010-08-09
1275720922 Jay Mermelstein Podiatrist 105 Stevens Ave, Suite 301, Mount Vernon, NY 10550-2686 2007-09-26
Find all providers in MOUNT VERNON

Competitor

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City MOUNT VERNON
Zip Code 62864

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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