Individual
JACOB D SILLAMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1380 E STROOP RD, KETTERING, OH 45429-4926
(937) 294-4356
(937) 297-2381
Mailing address
1380 E STROOP RD, KETTERING, OH 45429-4926
(937) 293-3486
(937) 293-3605
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50004125
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110639
—
OH
Enumeration date
09/17/2014
Last updated
11/23/2020
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