Provider Demographics
NPI:1043950470
Name:DAVILL, WAYTE (MD)
Entity type:Individual
Prefix:DR
First Name:WAYTE
Middle Name:
Last Name:DAVILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WAYTE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:405 W LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1107
Mailing Address - Country:US
Mailing Address - Phone:385-528-8258
Mailing Address - Fax:
Practice Address - Street 1:540 E CANFIELD ST RM 4374
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1928
Practice Address - Country:US
Practice Address - Phone:313-577-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program