Provider Demographics
NPI:1568558898
Name:WYLES, STEVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WYLES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 FRIENDSVILLE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7131
Mailing Address - Country:US
Mailing Address - Phone:330-263-8360
Mailing Address - Fax:330-263-8190
Practice Address - Street 1:3727 FRIENDSVILLE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7131
Practice Address - Country:US
Practice Address - Phone:330-263-8360
Practice Address - Fax:330-263-8190
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1571363A00000X
MI5601004340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630700Medicaid
OH2630700Medicaid
OHPA18422Medicare PIN