Individual
DAVID WYNCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 E DOUGLAS RD, SUITE 407, MISHAWAKA, IN 46545-1464
(574) 335-6500
Mailing address
707 E CEDAR ST, STE 200, SOUTH BEND, IN 46617-2057
(574) 335-6550
(574) 335-0791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01070512A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2011107870
—
IN
01
—
CN4033
MCARE RR GROUP
—
Enumeration date
06/11/2010
Last updated
09/14/2016
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