Provider Demographics
NPI:1629177035
Name:WAYNE, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WAYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:27275 HAGGERTY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3635
Mailing Address - Country:US
Mailing Address - Phone:248-741-6907
Mailing Address - Fax:248-721-8203
Practice Address - Street 1:42931 7 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-348-2442
Practice Address - Fax:248-348-4914
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383509551OtherPRIORITY HEALTH
E37419Medicare UPIN
MI383509551OtherPRIORITY HEALTH