Provider Demographics
NPI:1538915509
Name:MULLIKIN, TYLER WAYNE (DO)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:WAYNE
Last Name:MULLIKIN
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 1:5670 BENEDICT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4212
Mailing Address - Country:US
Mailing Address - Phone:937-901-4640
Mailing Address - Fax:
Practice Address - Street 1:81 MSGS/GME 301 FISHER ST, RM 5A127
Practice Address - Street 2:KEESLER AFB
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program