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Organization
WAYNE MEDICAL CENTER PLLC
Active
Organization
WAYNE MEDICAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MODINI C LIYANAGE M.D. (OWNER)
(734) 729-5780
Entity
Organization
Contact information
Practice address
1203 S WAYNE RD, WESTLAND, MI 48186-4362
(734) 729-5780
Mailing address
1203 S WAYNE RD, WESTLAND, MI 48186-4362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396960308
NPI TYPE 2
MI
05
—
4626563
—
MI
01
—
DD1992
RR MR
MI
Enumeration date
11/08/2016
Last updated
11/08/2016
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