1. Home
  2. Directory
  3. Michigan
  4. Detroit
  5. Student In An Organized Health Care Education Training Program
  6. NPI Profile

TYSON DON WALIEZER MD
NPI 1790348076
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since April 22, 2019PECOS Enrolled
4160 JOHN R STREET, HARPER PROFESSIONAL BUILDING, SUITE 615, DETROIT, MI 48201(313) 745-4195 Get Directions Write a Review

NPPES record last updated: April 2, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 2, 2020, Apr 22, 2019 (2 updates tracked since 2019).

About Tyson Don Waliezer Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYSON DON WALIEZER MD (NPI 1790348076) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since April 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1790348076
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameTYSON DON WALIEZERCredential: MD
Location Address4160 JOHN R STREET, HARPER PROFESSIONAL BUILDING, SUITE 615Detroit, MI 48201
Mailing Address25909 Clark StNovi, MI 48375-1622 · (360) 607-2703
Phone(313) 745-4195
Sole ProprietorNo
Enumeration DateApril 22, 2019
Last NPPES UpdateApril 2, 20202 updates tracked since enumeration
NPPES CertifiedApril 2, 2020
✔ NPI 1790348076 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
4160 JOHN R STREET, Detroit, MI 48201
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tyson Don Waliezer Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RAMARAO KAZA MD
Urology
4160 JOHN R STREET, SUITE 809
DETROIT, MI 48201
Wayne County (313) 831-2700
DR. MAYURA S MADANI MD
Pediatrics
4160 JOHN R STREET
DETROIT, MI 48201
Wayne County (313) 833-4629

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyson Waliezer's NPI number?

The NPI number for Tyson Waliezer is 1790348076. It was assigned to this individual provider in the NPPES registry on April 22, 2019.

Where is Tyson Waliezer located?

Tyson Waliezer practices at 4160 John R Street Harper Professional Building, Suite 615, Detroit, MI 48201. The listed phone number is (313) 745-4195.

What is Tyson Waliezer's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Tyson Waliezer enrolled in Medicare?

Yes. Tyson Waliezer is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tyson Waliezer was last updated on April 2, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.