Individual
WYNN W ADAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 296-7202
Mailing address
PO BOX 713083, COLUMBUS, OH 43271-3083
(614) 430-5707
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35042525
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0675434
—
OH
Enumeration date
05/09/2006
Last updated
11/15/2010
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