Individual
WAYNE A CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2122 GRANGE RD, BUCHANAN, MI 49107-9367
(269) 471-5186
(269) 471-5086
Mailing address
2122 GRANGE RD, BUCHANAN, MI 49107-9367
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
064990
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200981120
—
IN
05
—
4700197
—
MI
05
—
4707975
—
MI
01
—
WC064990
BC/BS
MI
Enumeration date
06/12/2006
Last updated
07/29/2010
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