Individual provider · Type 1 NPI
Tyler Wishau
Foot & Ankle Surgery Podiatrist · Mount Vernon, IL
NPI number
1144649856
Active
Practice location
2 Good Samaritan Way Ste 420
Mount Vernon, IL 62864-2478
Mailing address
PO Box 955860
St. Louis, MO 63195-2588
Other practice locations
- 12303 Depaul Dr., Bridgeton, MO 63044-2588 · (314) 344-6000
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist | 213E00000X | 016005806 (IL) |
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | 016005806 (IL) |
Foot & Ankle Surgery Podiatrist: Definition to come...
4 other providers at this address
About NPI 1144649856
Tyler Wishau's National Provider Identifier is 1144649856, issued on Apr 9, 2014. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Mount Vernon, IL. The record was last updated on Sep 29, 2026.