Healthcare Provider Details

I. General information

NPI: 1568483907
Provider Name (Legal Business Name): WAYNE J MYLES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

IV. Provider business mailing address

1702 LAFAYETTE RD
CRAWFORDSVILLE IN
47933-1033
US

V. Phone/Fax

Practice location:
  • Phone: 765-362-5100
  • Fax: 765-362-5171
Mailing address:
  • Phone: 765-362-5100
  • Fax: 765-362-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1717
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34006715
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: