Individual
JACOB WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9200 W WISCONSIN AVE, RADIATION ONCOLOGY, MILWAUKEE, WI 53226-3522
(414) 805-4400
(414) 805-4369
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-4400
(414) 805-4369
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11037
GA
2085R0001X
Radiation Oncology Physician
Primary
20929
ND
2085R0001X
Radiation Oncology Physician
Primary
86587-020
WI
2085R0001X
Radiation Oncology Physician
Primary
8658720
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100393881
—
WI
Enumeration date
03/17/2019
Last updated
02/23/2026
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