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Tyler Daniel Sharpe

Internal Medicine

Allopathic & Osteopathic Physicians

550 S Jackson St, Acb, A3h02, Louisville, KY 40202-1622

PECOS Enrollment

This provider is enrolled in PECOS as TYLER SHARPE.

Based on the most recent information from CMS, provider Tyler Daniel Sharpe is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1164788121
Provider Type
Individual
Full Name
Sharpe, Tyler Daniel
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
4/4/2012
Last Updated
8/27/2015

Contact Information

Practice Location

550 S Jackson St, Acb, A3h02, Louisville, KY 40202-1622

(502) 852-7041

Unlisted Fax

Mailing Location

550 S Jackson St, Acb, A3h02, Louisville, KY 40202-1622

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 47962 Kentucky
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License R3033 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 7100248210	Description Medicaid	Issuer Unlisted Kentucky

Tyler Daniel Sharpe

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

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License

Code

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License

Provider Identifiers

ID

Description

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Issuer

Gardon, Mark Anthony

Carter, Keith Baxter

Hiser-Kohler, Melissa M

Prebeck, Josh

Tammo, Sami

Spindel, Jeffrey

Murphy, Erin

Siddiqi, Kamran

Gevedon, Thomas Maxwell

Gerlach, Dylan Nathanael