TYLER CONWAY (NPI# 1104269000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104269000 |
| Entity Type | Individual |
| Full Name | TYLER CONWAY |
| Credential | MD |
| Practice Address |
500 Osborne Rd Ne Ste 255 Fridley MN 55432 |
| Mailing Address |
820 E Terra Cotta Ave Ste 125 Crystal Lake IL 60014-3650 |
| Practice Telephone | 7632362500 |
| Mailing Telephone | 8154557143 |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2018-08-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 036.147026 | IL | Allopathic & Osteopathic Physicians |
| N | 207N00000X | Dermatology | 62134 | MN | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1021 Bandana Blvd E Ste 100, Saint Paul, MN 551085109 | 6512419700 | |
| 500 Osborne Rd Ne Ste 255, Fridley, MN 554322768 | 7632362500 |
| Street Address |
500 OSBORNE RD NE STE 255 |
| City | FRIDLEY |
| State | MN |
| Zip Code | 55432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497728661 | Nader Bishara Ailabouni | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2006-02-08 |
| 1083226112 | Erin Kristine Church | Social Worker | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2020-08-19 |
| 1578058038 | Jessica Stewart | Nurse Practitioner | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2018-06-27 |
| 1437684602 | Alysse Victoria Cruz | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2017-04-25 |
| 1568823870 | Diana Lynn Heilig | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2016-03-14 |
| 1912203365 | Allina Health System | Clinic/Center | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2011-02-02 |
| 1538322243 | Nicole Kay Baker | Nurse Practitioner | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2008-07-03 |
| 1306911821 | Clinton Vanlith | Psychologist | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2006-11-21 |
| 1598727638 | Dale Lee Cody | Surgery | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2006-04-04 |
| 1952376675 | Chienyenwa N Nwachuku-winful | Family Medicine | 500 Osborne Rd Ne Ste 255, Fridley, MN 55432-2768 | 2006-02-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791177 | Adelyn Ruth Kopp | Occupational Therapist | 500 Osborne Rd Ne Suite 365, Fridley, MN 55432 | 2019-07-11 |
| 1831665603 | White Smiles Family Dentistry Pllc | Dentist | 1611 County Hwy 10, Minneapolis, MN 55432 | 2018-10-19 |
| 1518402213 | Peaceful Adult Day Center LLC. | Home Health | 6267 University Ave Ne, Fridley, MN 55432 | 2017-01-04 |
| 1205383742 | Farhiya Mahamud Gelle I | Durable Medical Equipment & Medical Supplies | 6329 5th Street Ne Apt 8, Fridley, MN 55432 | 2016-09-01 |
| 1093163164 | Christiane Schwecke | Specialist/Technologist | 8290 University Ave N, Fridley, MN 55432 | 2016-05-31 |
| 1336551563 | Amy White Mountain | Massage Therapist | 1611 County Hwy 10 Ne, Spring Lake Park, MN 55432 | 2014-05-22 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1952648180 | John Franklyn Marshall | Family Medicine | 480 Osborne Road Ne, Suite 100, Fridley, MN 55432 | 2013-01-08 |
| 1558610519 | Novacare Outpatient Rehabilitation East Inc | Clinic/Center | 480 Osborne Road, Number 280, Fridley, MN 55432 | 2012-09-06 |
| 1336423391 | Christian Restoration Services | Counselor | 7157 Commerce Circle W, Fridley, MN 55432 | 2011-10-07 |
| Find all providers in zip 55432 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1134108772 | Roger H Weenig | Dermatology | 7205 University Ave Ne, Fridley, MN 55432-3134 | 2006-01-12 |
| 1457885444 | Associated Skin Care Specialists | Dermatology | 7205 University Ave Ne, Fridley, MN 55432-3134 | 2017-04-17 |
| 1225292535 | Bailey C Lee | Dermatology | 7205 University Ave Ne, Fridley, MN 55432-3134 | 2008-07-16 |
| 1013103837 | Scott Paul Prawer | Dermatology | 7205 University Ave Ne, Fridley, MN 55432-3134 | 2007-09-16 |
| 1932150117 | Columbia Park Medical Group, Pa | Dermatology | 6401 University Ave Ne, Suite 200, Fridley, MN 55432-4341 | 2006-05-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962871608 | Lakes Dermatology, Pa | Dermatology | 14305 Southcross Dr W, Suite 110, Burnsville, MN 55306-7009 | 2015-09-23 |
| 1194133157 | Adam Schmitt | Dermatology | 2 Carlson Pkwy N Ste 240, Plymouth, MN 55447 | 2014-07-22 |
| 1578982773 | Lori Ann Fiessinger | Dermatology | 420 Delaware Street Se, Mmc 98, Minneapolis, MN 55455 | 2014-04-15 |
| 1033537782 | Erin Sellinger | Dermatology | 2 Carlson Pkwy N, Ste 240, Plymouth, MN 55447-4485 | 2014-03-31 |
| 1033555230 | Samuel Blake Ecker | Dermatology | 3655 Plymouth Blvd Ste 110, Minneapolis, MN 55446-3665 | 2013-05-14 |
| 1295078913 | Jessica Jane Newman | Dermatology | 4-240, Phillips-wangensteen Bldg., 516 Delaware Street S.e., Mail Code 98, Minneapolis, MN 55455 | 2013-04-01 |
| 1437416088 | Tiffany Lynn Shih | Dermatology | 401 Phalen Blvd # Ms 41102b, Saint Paul, MN 55130-5302 | 2012-04-20 |
| 1124317383 | Sara Anne Hylwa | Dermatology | 730 South 8th Street, Department of Dermatology, Minneapolis, MN 55415 | 2011-03-28 |
| 1770885360 | Thomas Joseph Kalb | Dermatology | 13420 106th St., Young America, MN 55397-5401 | 2010-12-02 |
| 1346550092 | John D Sarbacker | Dermatology | 1216 23rd Ave S, Moorhead, MN 56560-4536 | 2010-10-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.