MEDICARE: MITCHELL S. WAYNE, DPM, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	5901400097	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CE9028	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611678400	OTHER	MI	DEPARTMENT OF LABOR
3	4479604	OTHER	MI	AETNA HEALTHCARE
4	80395A	OTHER	MI	HEALTH PLUS OF MICHIGAN
5	0F372270	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1043282346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL S. WAYNE, DPM, PC

Provider Business Mailing Address
First Line	:	7001 ORCHARD LAKE RD
Second Line	:	SUITE 230B
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3604
Country	:	US
Telephone Number	:	248-855-3232
Fax Number	:	248-855-3338

Provider Business Practice Location Address
First Line	:	7001 ORCHARD LAKE RD
Second Line	:	SUITE 230B
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3604
Country	:	US
Telephone Number	:	248-855-3232
Fax Number	:	248-855-3338

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MITCHELL S WAYNE
Credential	:	DPM
Telephone Number	:	248-855-3232

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/25/2008

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