Healthcare Provider Details

I. General information

NPI: 1457770703
Provider Name (Legal Business Name): TIMOTHY C WYLIE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 READING RD STE 308
CINCINNATI OH
45241
US

IV. Provider business mailing address

32743 23 MILE RD STE 210
CHESTERFIELD MI
48047-2176
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-7755
  • Fax: 513-563-0768
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36003793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: