Provider Demographics
NPI:1659380863
Name:WAYNE NEUROLOGY PLC
Entity Type:Organization
Organization Name:WAYNE NEUROLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-721-4739
Mailing Address - Street 1:34815 W MICHIGAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1799
Mailing Address - Country:US
Mailing Address - Phone:734-721-4739
Mailing Address - Fax:734-721-9448
Practice Address - Street 1:34815 W MICHIGAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1799
Practice Address - Country:US
Practice Address - Phone:734-721-4739
Practice Address - Fax:734-721-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty