Provider Demographics
NPI:1083693790
Name:WAYNE, ANDREW MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843857
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3857
Mailing Address - Country:US
Mailing Address - Phone:314-966-8887
Mailing Address - Fax:314-317-1398
Practice Address - Street 1:555 N NEW BALLAS RD STE 175
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6884
Practice Address - Country:US
Practice Address - Phone:314-786-2663
Practice Address - Fax:314-279-1037
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106770208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2300970OtherUNITED HEALTH CARE
MO1213279001OtherCIGNA
MO106929OtherBLUE CROSS BLUE SHIELD
MO81445OtherGHP
MO099000OtherEXCLUSIVE CHOICE
MOF65905OtherMERCY #80
MO334564OtherHEALTHLINK
MO5919459OtherAETNA
MO009011314Medicare ID - Type UnspecifiedMEDICARE #8
MO2300970OtherUNITED HEALTH CARE
MO81445OtherGHP