Individual
MALYNDA SUZANNE WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 944-9400
(317) 963-1955
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
01090037A
IN
207X00000X
Orthopaedic Surgery Physician
R-11213
IA
207XP3100X
Pediatric Orthopaedic Surgery Physician
R-11213
IA
207XS0106X
Orthopaedic Hand Surgery Physician
R-11213
IA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
R-11213
IA
207XS0117X
Orthopaedic Surgery of the Spine Physician
R-11213
IA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
R-11213
IA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
R-11213
IA
207XX0801X
Orthopaedic Trauma Physician
Primary
01090037A
IN
207XX0801X
Orthopaedic Trauma Physician
R-11213
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430H73
MEDICARE PTAN
IN
05
—
300075533
—
IN
Enumeration date
05/30/2018
Last updated
11/22/2023
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