Provider Demographics
NPI:1245238120
Name:WYLES, BETHANY
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:WYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 HOPEWELL DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1579
Mailing Address - Country:US
Mailing Address - Phone:220-564-1755
Mailing Address - Fax:220-564-1756
Practice Address - Street 1:687 HOPEWELL DR BLDG 2
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1579
Practice Address - Country:US
Practice Address - Phone:220-564-1755
Practice Address - Fax:220-564-1756
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007778207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2386814Medicaid
OHH276950Medicare PIN