Healthcare Provider Details

I. General information

NPI: 1447909650
Provider Name (Legal Business Name): ELIZABETH MARIE WYLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SHAWNEE LN
CHILLICOTHEE OH
45601-4145
US

IV. Provider business mailing address

2768 WOODSVIEW DR APT 11
BEAVERCREEK OH
45431-7719
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4888
  • Fax: 740-779-4898
Mailing address:
  • Phone: 404-558-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number57.252334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: