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General NPI Number Information
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NPI Number | 1497290753
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Entity Type | Organization
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Legal Business Name | HOLLY KAY WYNESKI MD, LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 128 E MILLTOWN RD STE 205
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City | WOOSTER
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State | OH
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Zip | 44691-1276
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Country | US
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Telephone | 330-685-9920
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Fax |
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Provider Business Mailing Address
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Address Line | 4336 BRECKSVILLE RD STE B
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City | RICHFIELD
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State | OH
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Zip | 44286-9248
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOLLY K WYNESKI
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Credential | MD
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Telephone | 306-859-9203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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