Individual
KODY WYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 288-8320
(920) 288-8325
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
81429
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
036.159929
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
81429
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100286255
—
WI
Enumeration date
03/25/2017
Last updated
10/17/2024
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