Individual
PAUL MICHAEL WILDE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C, SC.D.
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6198
(913) 684-6128
Mailing address
5034 MUND RD, SHAWNEE, KS 66218-9147
(913) 422-8477
(913) 322-4562
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1002775 NCCPA
GA
Other
Enumeration date
07/29/2005
Last updated
07/08/2007
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