Provider Demographics
NPI:1033307376
Name:DE VERA, WYLIE CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:WYLIE
Middle Name:CRAIG
Last Name:DE VERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5501 NW 62ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-842-1974
Practice Address - Street 1:5501 NW 62ND TER STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2412
Practice Address - Country:US
Practice Address - Phone:816-842-4440
Practice Address - Fax:816-842-1974
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106085207R00000X
MO2022026486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine