Provider Demographics
NPI:1821093659
Name:COURT, WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:COURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4496
Mailing Address - Fax:419-998-4463
Practice Address - Street 1:525 N EASTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2268
Practice Address - Country:US
Practice Address - Phone:419-998-4496
Practice Address - Fax:419-998-4463
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010604582085R0001X
OH35-0715052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH920007304OtherRR MEDICARE
MI0N24000014OtherMEDICARE
OH2360743Medicaid
MI4449413OtherMI MEDICAID-OH LOCATIONS
MIP00028032OtherRR MEDICARE
MI4446903Medicaid
MI0N24000014OtherMEDICARE
OHF42682Medicare UPIN
OHCO4092332Medicare PIN