Individual
JILIAN WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
341 SENTINEL OAK DR, CENTERVILLE, OH 45458-4074
(937) 436-3833
Mailing address
341 SENTINEL OAK DR, CENTERVILLE, OH 45458-4074
(937) 436-3833
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35074883D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000235555
BC/BS
OH
05
—
2094611
—
OH
Enumeration date
02/22/2006
Last updated
05/14/2013
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