Michael Lee Wynn MD Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

00G398000 Issued in CA

Legal business name

MICHAEL LEE WYNN MD INC

Practice address

5601 Norris Canyon Rd
Suite 100
San Ramon, CA 94583

Phone

(925) 277-1055

Fax

(925) 277-1915

NPI assigned

Jul 9, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Lee Wynn, MDNPI 1285673996

Title

President

Phone

(925) 277-1055

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Lee Wynn, MD

  • Surgery Physician
  • San Ramon, CA
  • NPI 1285673996
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336172741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 NORRIS CANYON RD",
            "address_2": "SUITE 100",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "94583",
            "telephone_number": "925-277-1055",
            "fax_number": "925-277-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 NORRIS CANYON RD",
            "address_2": "SUITE 100",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "94583",
            "telephone_number": "925-277-1055",
            "fax_number": "925-277-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL LEE WYNN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-277-1055",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "00G398000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phylicia S Meyer
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• Susan Miao, PHARMD
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• Michael Duong, OD (Optometric Center and Eyewear Galleria)
• Michael T. Temkin DO, a Medical Corporation
• Nicole Midtlyng, PT
• Tatiana Mielezko
• Tatyana O Mikerina
• Ronald Miklebost, D.C.

• Surgery Physician in San Ramon, CA
• Providers in San Ramon, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.