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General NPI Number Information
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NPI Number | 1629177035
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Entity Type | Individual
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Provider Name | MICHAEL WAYNE DO
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 42931 7 MILE RD
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City | NORTHVILLE
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State | MI
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Zip | 48167-2277
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Country | US
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Telephone | 248-348-2442
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Fax | 248-348-4914
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Provider Business Mailing Address
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Address Line | 27275 HAGGERTY RD STE 500
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City | NOVI
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State | MI
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Zip | 48377-3635
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Country | US
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Telephone | 248-741-6907
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Fax | 248-721-8203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101007297
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License Number State | MI
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