Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901400097 | MI |
NPI | 1437121746 |
---|---|
Provider Name | Dr. Mitchell S Wayne |
First Address | West Bloomfield, MI 48322-3604 |
Second Address | West Bloomfield, MI 48322-3604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000012402 | CAPE HEALTH PLAN (01) | MI |
10105530003 | WELLNESS PLAN (01) | MI |
506728 | CARE CHOICES (01) | MI |
T34163 | (02) | MI |
T34163 | HAP (01) | MI |