Provider Demographics
NPI:1043282346
Name:MITCHELL S. WAYNE, DPM, PC
Entity Type:Organization
Organization Name:MITCHELL S. WAYNE, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-855-3232
Mailing Address - Street 1:7001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 230B
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3604
Mailing Address - Country:US
Mailing Address - Phone:248-855-3232
Mailing Address - Fax:248-855-3338
Practice Address - Street 1:7001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 230B
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3604
Practice Address - Country:US
Practice Address - Phone:248-855-3232
Practice Address - Fax:248-855-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400097213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI611678400OtherDEPARTMENT OF LABOR
MICE9028OtherRAILROAD MEDICARE
MI4479604OtherAETNA HEALTHCARE
MI80395AOtherHEALTH PLUS OF MICHIGAN
MI0F372270OtherBCBSM
MI0F37227Medicare PIN
MI0F372270OtherBCBSM
MI80395AOtherHEALTH PLUS OF MICHIGAN
MICE9028OtherRAILROAD MEDICARE