Wayne Medical Center PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301074724 Issued in MI

Legal business name

WAYNE MEDICAL CENTER PLLC

Practice address

1203 S Wayne Rd
Westland, MI 48186-4362

Phone

(734) 729-5780

Fax

(734) 729-7730

NPI assigned

Apr 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Modini Chinta Liyanage, M.D.

Title

President

Phone

(734) 729-5780

Specialties & licenses 1

Addresses

Other identifiers 12

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1396960308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 S WAYNE RD",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481864362",
            "telephone_number": "734-729-5780",
            "fax_number": "734-729-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 S WAYNE RD",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481864362",
            "telephone_number": "734-729-5780",
            "fax_number": "734-729-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "LIYANAGE",
        "authorized_official_first_name": "MODINI",
        "authorized_official_middle_name": "CHINTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-729-5780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USPOSTAL WORKMEN COMP",
            "identifier": "611793200",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "139077",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE GROUP NUMBER",
            "identifier": "K583",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH PLAN",
            "identifier": "023685",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP NUMBER",
            "identifier": "700H221880",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN GROUP NUMBER",
            "identifier": "700H221880",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE INDIVIDUAL NUMBER",
            "identifier": "16625",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7589557",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAP NUMBER",
            "identifier": "H98425",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00213848",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "139077",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4626563",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelly Watson, LLPC
• Tanya Watson
• Marguerite Wilhemina Way
• Wayne Group Systems, Inc.
• Wayne Medical Center PLLC
• Wayne Pharmacy, LLC
• Candace Weaver, LMSW-C
• Karen Weaver, MD
• Theresa Ann Weaver
• Erica Dawn Webb, PHARM.D.

• Family Medicine Physician in Westland, MI
• Providers in Westland, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.