Provider Demographics
NPI:1770535189
Name:WYATT, DAVID T (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:WYATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC ENDOCRINOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6750
Mailing Address - Fax:414-266-6749
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC ENDOCRINOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6750
Practice Address - Fax:414-266-6749
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI265212080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770535189Medicaid
002000139COtherHUMANA
WI68086 0830Medicare PIN
WI1770535189Medicaid
WI73601 2079Medicare PIN
WI73601 2079Medicare PIN