Healthcare Provider Details

I. General information

NPI: 1053605592
Provider Name (Legal Business Name): WYLIE CARHARTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W THUNDERBIRD RD STE 110
PEORIA AZ
85381-4451
US

IV. Provider business mailing address

518 W CYPRESS ST
PHOENIX AZ
85003-1107
US

V. Phone/Fax

Practice location:
  • Phone: 855-776-7266
  • Fax:
Mailing address:
  • Phone: 602-826-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50795
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50795
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: