Thomas G. Wayne M.D., P.L.L.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301047530 Issued in MI

Legal business name

THOMAS G. WAYNE M.D., P.L.L.C.

Practice address

4150 S River Rd
Suite1
East China, MI 48054-2915

Phone

(810) 326-0858

Fax

(810) 326-0933

NPI assigned

Nov 11, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Thomas G Wayne, M.D.

Title

Owner

Phone

(810) 326-0858

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1289433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289433600000",
    "number": "1508167206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 S. RIVER RD.",
            "address_2": "SUITE1",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542915",
            "telephone_number": "810-326-0858",
            "fax_number": "810-326-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 S RIVER RD",
            "address_2": "SUITE1",
            "city": "EAST CHINA",
            "state": "MI",
            "postal_code": "480542915",
            "telephone_number": "810-326-0858",
            "fax_number": "810-326-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS G. WAYNE M.D., P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-11",
        "last_updated": "2010-11-11",
        "status": "A",
        "authorized_official_last_name": "WAYNE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-326-0858",
        "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": "4301047530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "ON22610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0807408272",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4277711",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2010; 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.