Healthcare Provider Details

I. General information

NPI: 1154382059
Provider Name (Legal Business Name): LINDSAY MICHELLE WILES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TAMPA GENERAL CIR STE 410
TAMPA FL
33606-3578
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7473
  • Fax: 813-844-1966
Mailing address:
  • Phone: 813-844-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME109487
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberME109487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: