Provider Demographics
NPI:1144979089
Name:MILLO, TYLER JOESPH (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOESPH
Last Name:MILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2626
Mailing Address - Country:US
Mailing Address - Phone:334-301-2562
Mailing Address - Fax:
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR RM 714
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:215-434-3475
Practice Address - Fax:251-434-3837
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.5797R207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program