MEDICARE: DR. MITCHELL S WAYNE DPM

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T34163	OTHER	MI	HAP
2	000000012402	OTHER	MI	CAPE HEALTH PLAN
3	10105530003	OTHER	MI	WELLNESS PLAN
4	506728	OTHER	MI	CARE CHOICES

General Provider Information

NPI Number	:	1437121746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL S WAYNE DPM

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	:	248-855-3232

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	:	248-855-3232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/08/2008

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Directions to “ DR. MITCHELL S WAYNE DPM” Practice Location

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