Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tyler Clark, MD

Individual provider Family Medicine Physician · NPI 1124414305

Tyler Clark, MD is a Family Practice in Coeur D Alene, Idaho. Qualified in 2015, 11 years ago. Practices with Kootenai Health Inc, a 394-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
11
Licensed in
ID
In the registry since
2015
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1701 Lincoln Way
Coeur D Alene, ID 83814-2537
Phone: (208) 625-4955
Fax: (208) 625-4956
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence M-14362 (ID)

Record details

NPI number1124414305
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 14, 2015
Last updated in NPPESApril 16, 2024
Certification dateApril 16, 2024
Mailing address2003 Kootenai Health Way, Coeur D Alene, ID 83814-6051

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Kootenai Health Inc — 394 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Coeur D Alene