MEDICARE: KATHRYN V WILDER AU.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
1	231H00000X	Audiologist	AY338	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	640001185	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	S1037	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891798419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN V WILDER AU.D.

Provider Business Mailing Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	STE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Provider Business Practice Location Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	STE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	02/26/2009

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