Provider Demographics
NPI:1801845433
Name:WYLIE, CARA M (DPM)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:M
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 1:1635 AURORA CT
Mailing Address - Street 2:MAIL STOP F713
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2541
Mailing Address - Country:US
Mailing Address - Phone:720-848-2785
Mailing Address - Fax:720-848-2608
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:MAIL STOP F713
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:720-848-2785
Practice Address - Fax:720-848-2608
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO536638OtherMEDICARE
CO53252829Medicaid
CO536638OtherMEDICARE