Healthcare Provider Details

I. General information

NPI: 1245238120
Provider Name (Legal Business Name): DR. BETHANY WYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 HOPEWELL DR BLDG 2
HEATH OH
43056-1579
US

IV. Provider business mailing address

687 HOPEWELL DR BLDG 2
HEATH OH
43056-1579
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-1755
  • Fax: 220-564-1756
Mailing address:
  • Phone: 220-564-1755
  • Fax: 220-564-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34-007778
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: