Healthcare Provider Details

I. General information

NPI: 1972553774
Provider Name (Legal Business Name): JOHN D WYRICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE SUITE 2200
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

6480 HARRISON AVE
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8690
  • Fax: 513-475-7243
Mailing address:
  • Phone: 513-354-3700
  • Fax: 513-354-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35052959W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: