| Organization Name: | MITCHELL S. WAYNE, DPM, PC |
| NPI Number: | 1043282346 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MITCHELL S WAYNE (PRESIDENT/OWNER) |
| Mailing Address: | 7001 Orchard Lake Rd Suite 230b West Bloomfield |
| State: | MI US |
| Postal Code: | 483223604 |
| Phone Number: | 2488553232 |
| Fax Number: | 2488553338 |
| NPI Enumeration Date: | 02/02/2006 |
| NPI Last Update Date: | 07/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 5901400097 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |