Healthcare Provider Details

I. General information

NPI: 1497731640
Provider Name (Legal Business Name): KATHLEEN L. WYNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE FL 2
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-3333
  • Fax: 614-366-0345
Mailing address:
  • Phone: 614-685-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35.124567
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberJ3004
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: