Provider Demographics
NPI:1427006832
Name:YOUNG, DAVID WAYNE (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 LONG LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-7495
Mailing Address - Country:US
Mailing Address - Phone:269-329-2947
Mailing Address - Fax:
Practice Address - Street 1:420 W HIGH ST
Practice Address - Street 2:BORGESS-LEE MEMORIAL ED
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1943
Practice Address - Country:US
Practice Address - Phone:269-783-3000
Practice Address - Fax:269-783-3005
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075673207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45481171Medicaid
MIH93319Medicare UPIN