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General NPI Number Information
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NPI Number | 1902208309
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Entity Type | Individual
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Provider Name | JACOB D SILLAMAN PA
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Gender | Male
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 1380 E STROOP RD
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City | KETTERING
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State | OH
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Zip | 45429-4926
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Country | US
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Telephone | 937-294-4356
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Fax | 937-297-2381
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Provider Business Mailing Address
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Address Line | 1380 E STROOP RD
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City | KETTERING
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State | OH
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Zip | 45429-4926
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Country | US
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Telephone | 937-293-3486
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Fax | 937-293-3605
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50004125
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License Number State | OH
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