Individual
MR. KEVIN T WYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-0001
(608) 262-2398
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001734
IA
363A00000X
Physician Assistant
055.0030930
VT
363A00000X
Physician Assistant
085002558
IL
363A00000X
Physician Assistant
Primary
2909-23
WI
363AS0400X
Surgical Physician Assistant
085002558
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100024390
—
WI
01
—
28783
WELLMARK BCBS
IA
Enumeration date
11/15/2005
Last updated
04/19/2023
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