Provider Demographics
NPI:1952455719
Name:MAUMEE HEALTH & WELLNESS ASSOCIATES INC
Entity Type:Organization
Organization Name:MAUMEE HEALTH & WELLNESS ASSOCIATES INC
Other - Org Name:DWIGHT E BRYAN DO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-887-0896
Mailing Address - Street 1:5757 MONCLOVA RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-887-0896
Mailing Address - Fax:419-893-3046
Practice Address - Street 1:5757 MONCLOVA RD
Practice Address - Street 2:SUITE 17
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1863
Practice Address - Country:US
Practice Address - Phone:419-887-0896
Practice Address - Fax:419-893-3046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00343732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0704054Medicaid
OHCK6399OtherMEDICARE RAILROAD
=========OtherTAX ID
OH0704054Medicaid