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NPI Code Detail

MEDICARE: DR. JONATHAN WYNSTRA M.D.

MEDICARE: DR. JONATHAN WYNSTRA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician31915KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235132960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN WYNSTRA M.D.
Provider Business Mailing Address
First Line : 1111 MEDICAL CENTER CIR
Second Line :
City : MAYFIELD
State : KY
Zip : 42066-1194
Country : US
Telephone Number : 270-251-4543
Fax Number : 270-251-4544
Provider Business Practice Location Address
First Line : 1111 MEDICAL CENTER CIR
Second Line :
City : MAYFIELD
State : KY
Zip : 42066-1194
Country : US
Telephone Number : 270-251-4543
Fax Number : 270-251-4544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2005
Last Update Date : 10/27/2014

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