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NPI Code Detail

MEDICARE: MICHAEL WYNNE RBT

MEDICARE: MICHAEL WYNNE RBT
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
1106S00000XBehavior TechnicianRBT-20-145195IN

General Provider Information

NPI Number : 1821816190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL WYNNE RBT
Provider Business Mailing Address
First Line : 4844 PINE AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46327-1843
Country : US
Telephone Number : 219-341-7706
Fax Number :
Provider Business Practice Location Address
First Line : 4840 GRASSELLI ST
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3503
Country : US
Telephone Number : 219-341-7706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2024
Last Update Date : 03/27/2025

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