Provider Demographics
NPI:1972922375
Name:GWIN, LILA (MD)
Entity type:Individual
Prefix:DR
First Name:LILA
Middle Name:
Last Name:GWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LINCOLN PARK BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6404
Mailing Address - Country:US
Mailing Address - Phone:937-294-4487
Mailing Address - Fax:937-294-2255
Practice Address - Street 1:500 LINCOLN PARK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6404
Practice Address - Country:US
Practice Address - Phone:937-294-4487
Practice Address - Fax:937-294-2255
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220813Medicaid