MEDICARE: WAYNE GROUP SYSTEMS, INC.

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1720276942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE GROUP SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	2074 S WAYNE RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-5428
Country	:	US
Telephone Number	:	734-722-8054
Fax Number	:	734-722-8419

Provider Business Practice Location Address
First Line	:	2074 S WAYNE RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48186-5428
Country	:	US
Telephone Number	:	734-722-8054
Fax Number	:	734-722-8419

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEYSIS MONTALVO
Credential	:
Telephone Number	:	786-343-5799

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	01/11/2008

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