Provider Demographics
NPI:1235172669
Name:CHAMBERS, WAYNE A (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29809 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1935
Mailing Address - Country:US
Mailing Address - Phone:734-676-1861
Mailing Address - Fax:
Practice Address - Street 1:29809 E RIVER RD
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-1935
Practice Address - Country:US
Practice Address - Phone:734-676-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430318207L00000X
MI4301055158207L00000X
OH35061084207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0812400Medicaid
300067305 1063493948OtherHEALTHNET
MI3427215-10Medicaid
OH0812400Medicaid
0690149Medicare PIN
$$$$$$$$$00OtherOHIO BWC
MI0E86029007Medicare ID - Type Unspecified
MI050056010Medicare ID - Type UnspecifiedRAILROAD MEDICARE
300067305 1063493948OtherHEALTHNET