National Provider Identifier

Michael Todd Tyson X

Michael Todd Tyson X is listed in the NPPES registry with a primary specialty of Driver in Rochester, NY and a listed phone number of (585) 532-0636.

NPI 1184147142Rochester, NYDriver

Profile Overview

NPI
1184147142
Provider Type
Individual
Primary Specialty
Driver
Enumeration Date
July 21, 2017
Last Updated
July 21, 2022

Practice Location

  • 696 Woodbine Ave
  • Rochester, NY 14619-2030

Phone: (585) 532-0636

Specialties

  • Driver (172A00000X)
Full Record
NPI
1184147142
Entity Type
Individual
Last Name
Tyson
First Name
Michael
Middle Name
Todd
Name Prefix
Mr.
Name Suffix
X
Mailing Street Address
696 Woodbine Ave
Mailing City
Rochester
Mailing State
NY
Mailing ZIP Code
14619-2030
Mailing Country
US
Mailing Phone
(585) 532-0636
Practice Street Address
696 Woodbine Ave
Practice City
Rochester
Practice State
NY
Practice ZIP Code
14619-2030
Practice Country
US
Practice Phone
(585) 532-0636
Enumeration Date
July 21, 2017
Last Updated
July 21, 2022
Sex
Male
Sole Proprietor
Yes
Taxonomy Group 1
193400000X Single Specialty Group
updated_by_file
npidata_pfile_20050523-20260308.csv
Taxonomies
Driver (172A00000X)