Provider Demographics
NPI:1447458096
Name:WAIT, BETHANY ANN (DO)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:WAIT
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:8003 CASTLEWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1946
Mailing Address - Country:US
Mailing Address - Phone:317-576-1335
Mailing Address - Fax:317-343-6562
Practice Address - Street 1:1901 W WESTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-3521
Practice Address - Country:US
Practice Address - Phone:574-234-9033
Practice Address - Fax:574-847-7200
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-06-22
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Provider Licenses
StateLicense IDTaxonomies
IN02003383A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02003383AOtherPHYSICIAN