Individual
KYLE WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1725 W HARRISON ST STE 1106, CHICAGO, IL 60612-3845
(312) 942-5000
Mailing address
409 CANAL COURT NORTH DR APT I, INDIANAPOLIS, IN 46202-4641
(626) 590-7901
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
036.160715
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/20/2018
Last updated
06/14/2022
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