Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 35067189 | OH |
NPI | 1083607451 |
---|---|
Provider Name | Michael D Waite |
First Address | Columbus, OH 43220-0452 |
Second Address | Columbus, OH 43214-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0987875 | (05) | OH |
WA4046881 | RR MEDICARE (01) | OH |