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Organization
THOMAS G. WAYNE M.D., P.L.L.C.
Active
Organization
THOMAS G. WAYNE M.D., P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS G WAYNE M.D. (OWNER)
(810) 326-0858
Entity
Organization
Contact information
Practice address
4150 S RIVER RD, SUITE1, EAST CHINA, MI 48054-2915
(810) 326-0858
(810) 326-0933
Mailing address
4150 S. RIVER RD., SUITE1, EAST CHINA, MI 48054-2915
(810) 326-0858
(810) 326-0933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301047530
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0807408272
BCBSM
—
05
—
4277711
—
MI
01
—
ON22610
MEDICARE ID-TYPE UNSPECIFIED
—
Enumeration date
11/11/2010
Last updated
11/11/2010
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