Tyler John Back (NPI# 1144704867, PAC ID# 9931452877) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1144704867 |
| PAC ID by PECOS | 9931452877 |
| Professional Enrollment ID | I20181023003031 |
| Full Name | Tyler John Back |
| Organization Legal Name | MINNESOTA UROLOGY PA |
| Address |
360 Sherman St Suite 450 Saint Paul MN 55102-2562 |
| Phone Number | 6519996800 |
| Gender | M |
| Graduation Year | 2018 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0840183984 |
| Number of Group Practice Members | 53 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 240001 | NORTH MEMORIAL MEDICAL CENTER |
| 240214 | MAPLE GROVE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 | 6519996800 | MINNESOTA UROLOGY PA |
| Organization Legal Name | MINNESOTA UROLOGY PA |
| Physicians | 56 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joseph Thomas Mahon | Urology | Minnesota Urology Pa | 7500 France Ave S, Edina, MN 55435-3400 |
| Maisy M Sanneman | Physician Assistant | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Randolph K Peterson | Pathology | Minnesota Urology Pa | 6525 France Ave S, Suite 208, Edina, MN 55435-2148 |
| Maxine Rae Gustafson | Physician Assistant | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Maria Teresa Chmielewski | Certified Clinical Nurse Specialist (cns) | Minnesota Urology Pa | 2945 Hazelwood St, Suite 220, Maplewood, MN 55109-1241 |
| Peter D Sershon | Urology | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| William J Utz | Urology | Minnesota Urology Pa | 6525 France Ave S, Suite 208, Edina, MN 55435-2148 |
| Hoo Yin Wong | Urology | Minnesota Urology Pa | 500 Osborne Rd Ne, Suite 120, Fridley, MN 55432-2767 |
| Todd Daniel Fleming | Urology | Minnesota Urology Pa | 911 Northland Dr, Princeton, MN 55371-2172 |
| Paul T Fadden | Urology | Minnesota Urology Pa | 6525 France Ave S, Suite 208, Edina, MN 55435-2148 |
| Street Address |
360 SHERMAN ST SUITE 450 |
| City | SAINT PAUL |
| State | MN |
| Zip | 55102-2562 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Maisy M Sanneman | Physician Assistant | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Maxine Rae Gustafson | Physician Assistant | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Angela Jane Everson | Physical Therapy | National Dizzy and Balance Center Ltd | 360 Sherman St, Suite 390, Saint Paul, MN 55102-2564 |
| Peter D Sershon | Urology | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Robert D Fisher | Urology | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Steven G Santino | Physical Medicine and Rehabilitation | Lakes Area Health Center Pllc | 360 Sherman St, Suite 400, Saint Paul, MN 55102-2425 |
| Patricia S Maetzold | Physical Therapy | National Dizzy and Balance Center Ltd | 360 Sherman St, Suite 390, Saint Paul, MN 55102-2564 |
| David N Prall | Urology | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Lauren L Babcock | Physician Assistant | Minnesota Urology Pa | 360 Sherman St, Suite 450, Saint Paul, MN 55102-2562 |
| Joel I Gedan | Neurology | 360 Sherman St, Suite 290, Saint Paul, MN 55102-2564 | |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Reid A Martinson | Anesthesiology | Associated Anesthesiologists Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Nathan M Frink | Internal Medicine | Healtheast Medical Research Institute | 69 Exchange W St, Saint Paul, MN 55102-1004 |
| Orren Wexler | Internal Medicine | Healtheast Medical Research Institute | 69 Exchange W St, Saint Paul, MN 55102-1004 |
| Faisal M Choudhry | Anesthesiology | Associated Anesthesiologists Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Mueni C Mualuko | Nurse Practitioner | Healtheast Medical Research Institute | 69 Exchange W St, Saint Paul, MN 55102-1004 |
| Joshua B Colton | Gastroenterology | Minnesota Gastroenterology Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Genet N Ghebre | Nurse Practitioner | Healtheast Medical Research Institute | 69 Exchange W St, Saint Paul, MN 55102-1004 |
| Thomas Christopher Sanneman | Anesthesiology | Associated Anesthesiologists Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Douglas B Nelson | Gastroenterology | Minnesota Gastroenterology Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Patrick M Oreilly | Gastroenterology | Minnesota Gastroenterology Pa | 69 Exchange St W, Saint Paul, MN 55102-1004 |
| Find all physicians in zip 55102 | |||
| City | SAINT PAUL |
| Zip Code | 55102 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | SAINT PAUL + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Tyler John Back.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.