Provider Demographics
NPI:1265628622
Name:WAIT, CECILY LIVINGSTONE (MD)
Entity type:Individual
Prefix:DR
First Name:CECILY
Middle Name:LIVINGSTONE
Last Name:WAIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7677 OAKPORT ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-1975
Mailing Address - Country:US
Mailing Address - Phone:510-422-3522
Mailing Address - Fax:510-379-7440
Practice Address - Street 1:420 DELAWARE ST SE
Practice Address - Street 2:14-100 PHILLIPS WAGENSTEIN BLDG MMC 391
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0341
Practice Address - Country:US
Practice Address - Phone:612-624-0990
Practice Address - Fax:612-625-3238
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA119745207R00000X
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program