Basic Information
| Provider Information | |||||||||
| NPI: | 1447664289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAYNE KIDNEY SPECIALIST PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20280 MIDDLEBELT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489871270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20280 MIDDLEBELT RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489871270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 10/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | SHARMA | ||||||||
| AuthorizedOfficialFirstName: | NEETU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2489871270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.