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NPI Code Detail

MEDICARE: WAYNE NEUROLOGY PLC

MEDICARE: WAYNE NEUROLOGY PLC
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
1174400000XSpecialist
22084N0400XNeurology Physician

General Provider Information

NPI Number : 1659380863
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAYNE NEUROLOGY PLC
Provider Business Mailing Address
First Line : 34815 W MICHIGAN AVE
Second Line : SUITE C
City : WAYNE
State : MI
Zip : 48184-1799
Country : US
Telephone Number : 734-721-4739
Fax Number : 734-721-9448
Provider Business Practice Location Address
First Line : 34815 W MICHIGAN AVE
Second Line : SUITE C
City : WAYNE
State : MI
Zip : 48184-1799
Country : US
Telephone Number : 734-721-4739
Fax Number : 734-721-9448
Authorized Official
Title or Position : OWNER
Name : MATTHEW HOLTZMAN
Credential :
Telephone Number : 734-721-4739
Provider Enumeration Date : 08/05/2006
Last Update Date : 04/27/2023

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Practice Fax:

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