Individual
BETHANY ANN WAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1901 W WESTERN AVE STE B, SOUTH BEND, IN 46619-3521
(574) 234-9033
(574) 847-7200
Mailing address
8003 CASTLEWAY DR, INDIANAPOLIS, IN 46250-1946
(317) 576-1335
(317) 343-6562
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003383A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02003383A
PHYSICIAN
IN
Enumeration date
07/05/2007
Last updated
06/22/2023
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