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General NPI Number Information
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NPI Number | 1760015622
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Entity Type | Organization
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Legal Business Name | WAYNE PEDIATRICS INC.
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 400 MACK AVE
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City | DETROIT
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State | MI
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Zip | 48201-2136
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Country | US
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Telephone | 313-577-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 656 KIRBY, 4249 F.A.B.
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City | DETROIT
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State | MI
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Zip | 48202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HERMAN GRAY
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Credential | MD
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Telephone | 313-577-3231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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