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General NPI Number Information
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NPI Number | 1316126576
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Entity Type | Organization
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Legal Business Name | WAYNE INTERNAL MEDICINE
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 11/03/2007
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Provider Practice Location Address
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Address Line | 128 EAST MILLTOWN ROAD SUITE 101
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City | WOOSTER
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State | OH
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Zip | 44691-6109
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Country | US
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Telephone | 330-262-1700
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Fax | 330-345-8980
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Provider Business Mailing Address
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Address Line | PO BOX 1206
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City | WOOSTER
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State | OH
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Zip | 44691-7083
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Country | US
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Telephone | 330-262-1700
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Fax | 330-345-8980
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OSAMA MITRI
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Credential | MD
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Telephone | 330-262-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35077131
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License Number State | OH
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