Provider Demographics
NPI:1346488954
Name:LINDY WYATT MD LLC
Entity type:Organization
Organization Name:LINDY WYATT MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:937-672-4730
Mailing Address - Street 1:PO BOX 42370
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0370
Mailing Address - Country:US
Mailing Address - Phone:937-672-4730
Mailing Address - Fax:513-433-5475
Practice Address - Street 1:6406 THORNBERRY CT
Practice Address - Street 2:SUITE 220B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7880
Practice Address - Country:US
Practice Address - Phone:937-672-4730
Practice Address - Fax:513-433-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-072489OtherOH LICENSE
10831537OtherCAQH
OH2018579Medicaid
OH439-96-3405-00OtherBWC
G58818OtherUPIN
W10833872Medicare PIN