Individual
DR. ROBERT L WYENANDT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-8074
(859) 301-4945
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(859) 301-8074
(859) 301-4945
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
30652
KY
208M00000X
Hospitalist Physician
Primary
30652
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200407630
—
IN
05
—
2401243
—
OH
05
—
64306525
—
KY
01
—
P01555163
RR MEDICARE
KY
Enumeration date
10/03/2005
Last updated
03/10/2022
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