Healthcare Provider Details

I. General information

NPI: 1972922375
Provider Name (Legal Business Name): LILA GWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LINCOLN PARK BLVD STE 220
KETTERING OH
45429-6404
US

IV. Provider business mailing address

500 LINCOLN PARK BLVD STE 220
KETTERING OH
45429-6404
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-4487
  • Fax: 937-294-2255
Mailing address:
  • Phone: 937-294-4487
  • Fax: 937-294-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.128779
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: