Physician Compare National (NPI:1497862189)

HEALTHCARE PROVIDER: TERRY A WYNN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1497862189
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719031301
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150903001277
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WYNN
	Individual professional last name
Provider First Name	TERRY
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	14103 FENKELL ST
	Group Practice or individual's line 1 address
City	DETROIT
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	482273214
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE HOSP AND MED CTRS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y