Provider Demographics
NPI:1609813310
Name:WAYNE H CASE MD PA
Entity Type:Organization
Organization Name:WAYNE H CASE MD PA
Other - Org Name:FAMILY MEDICAL CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-558-3571
Mailing Address - Street 1:3410 W 84 ST
Mailing Address - Street 2:STE 110 BLDG F
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-558-3571
Mailing Address - Fax:305-558-3682
Practice Address - Street 1:3410 W 84 ST
Practice Address - Street 2:STE 110 BLDG F
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-558-3571
Practice Address - Fax:305-558-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0019774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D59767Medicare UPIN
FLK0584Medicare PIN