Provider Demographics
NPI:1780030197
Name:WYLIE, SADIE CHRISTINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SADIE
Middle Name:CHRISTINE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERCHANT ST
Mailing Address - Street 2:STE 220 - ATTN CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-645-9827
Practice Address - Street 1:11560 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3527
Practice Address - Country:US
Practice Address - Phone:513-851-7700
Practice Address - Fax:513-851-1046
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000635213ES0103X
390200000X
OH36.003900213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program