Individual
KYLE MICHAEL WIEDEMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 HOSPITAL DR STE 110, WINCHESTER, KY 40391-7624
(859) 737-6572
Mailing address
225 HOSPITAL DR STE 110, WINCHESTER, KY 40391-7624
(859) 737-6572
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC115
KY
Other
Enumeration date
06/03/2020
Last updated
11/02/2021
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