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General NPI Number Information
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NPI Number | 1720276942
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Entity Type | Organization
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Legal Business Name | WAYNE GROUP SYSTEMS, INC.
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 2074 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5428
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Country | US
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Telephone | 734-722-8054
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Fax | 734-722-8419
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Provider Business Mailing Address
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Address Line | 2074 S WAYNE RD
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City | WESTLAND
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State | MI
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Zip | 48186-5428
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Country | US
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Telephone | 734-722-8054
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Fax | 734-722-8419
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEYSIS MONTALVO
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Credential |
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Telephone | 786-343-5799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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