Healthcare Provider Details

I. General information

NPI: 1093876716
Provider Name (Legal Business Name): MICHAEL M WYDILA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 SILVERSIDE RD STE 4B
WILMINGTON DE
19810-4434
US

IV. Provider business mailing address

1403 SILVERSIDE RD STE 4B
WILMINGTON DE
19810-4434
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-8070
  • Fax: 302-798-5902
Mailing address:
  • Phone: 302-798-8070
  • Fax: 302-798-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL MARTIN WYDILA
Title or Position: PRESIDENT AND OWNER
Credential: MD
Phone: 302-798-8070