Provider Demographics
NPI:1205494994
Name:PETREE, TYLER ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROBERT
Last Name:PETREE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TYLER
Other - Middle Name:ROBERT
Other - Last Name:PETREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3816 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2062
Mailing Address - Country:US
Mailing Address - Phone:214-675-0240
Mailing Address - Fax:
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-966-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program