Individual
DAVID A. WREDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
Mailing address
765 WINTER HILL LN, LEXINGTON, KY 40509-1961
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21485
KY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
21485
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000053336
BLUE CROSS BLUE SHIELD
KY
01
—
000000532758
BCBS PROVIDER NUMBER
KY
05
—
64214851
—
KY
Enumeration date
06/06/2006
Last updated
09/18/2015
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