Provider Demographics
NPI:1659453520
Name:MCGLOTHLIN, WYLIE G (MD)
Entity Type:Individual
Prefix:DR
First Name:WYLIE
Middle Name:G
Last Name:MCGLOTHLIN
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:PO BOX 652
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0652
Mailing Address - Country:US
Mailing Address - Phone:765-599-3400
Mailing Address - Fax:765-599-3500
Practice Address - Street 1:2200 FOREST RIDGE PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-599-3400
Practice Address - Fax:765-599-3500
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01026722207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2000563106Medicaid
IN200056310Medicaid
IN200056310Medicaid
IN2000563106Medicaid