Individual
MATTHEW STEVENSON WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12200 FAIRHILL RD, CLEVELAND, OH 44120-1058
(216) 844-6300
Mailing address
21076 BYRON RD, SHAKER HTS, OH 44122-2915
(216) 844-6338
(216) 844-6338
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
35-069734
OH
207R00000X
Internal Medicine Physician
35-069734
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221142
UNISON
OH
01
—
000000524532
ANTHEM
OH
05
—
2063672
—
OH
05
—
2073672
—
OH
01
—
414697
WELLCARE
OH
01
—
5496574
AETNA
OH
01
—
751025
BUCKEYE
OH
01
—
P00402008
MEDICARE RAILROAD
OH
Enumeration date
01/11/2006
Last updated
12/05/2008
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