Individual
ALLEN WYLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38891
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
388912
—
SC
01
—
SCA8545019
MEDICARE PIN
SC
01
—
SCA8549068
MEDICARE PIN
SC
Enumeration date
06/13/2014
Last updated
01/20/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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