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NPI Code Detail

MEDICARE: JACOB WYNNE M.D.

MEDICARE: JACOB WYNNE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician8658720WI

General Provider Information

NPI Number : 1508325861
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB WYNNE M.D.
Provider Business Mailing Address
First Line : 9200 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-805-4400
Fax Number : 414-805-4369
Provider Business Practice Location Address
First Line : 9200 W WISCONSIN AVE
Second Line : RADIATION ONCOLOGY
City : MILWAUKEE
State : WI
Zip : 53226-3522
Country : US
Telephone Number : 414-805-4400
Fax Number : 414-805-4369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2019
Last Update Date : 01/13/2026

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