Provider Demographics
NPI:1609174366
Name:WAYNE PHYSICIAN SERVICES PC
Entity Type:Organization
Organization Name:WAYNE PHYSICIAN SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-832-8008
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE #1125
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-832-8008
Mailing Address - Fax:
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:SUITE #1125
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:313-832-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty