Individual
DR. BRIAN PAUL WYNIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5122 MILLWRIGHT CT, INDIANAPOLIS, IN 46254-4786
(605) 359-0792
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R11262
IA
2085R0202X
Diagnostic Radiology Physician
Primary
02005796A
IN
2085R0202X
Diagnostic Radiology Physician
R11262
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306330980
RESIDENT LICENSE
IA
05
—
300026972
—
IN
01
—
959090193
MEDICARE PTAN
IN
Enumeration date
06/18/2018
Last updated
09/15/2023
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