MEDICARE: DR. KYLE EDWARD WEDIN M.D., PH.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
1	207R00000X	Internal Medicine Physician	Q5951	TX

General Provider Information

NPI Number	:	1588920706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE EDWARD WEDIN M.D., PH.D.

Provider Business Mailing Address
First Line	:	1950 RECORD CROSSING RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6223
Country	:	US
Telephone Number	:	214-640-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 RECORD CROSSING RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6223
Country	:	US
Telephone Number	:	214-640-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	10/25/2015

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