Provider Demographics
NPI:1063588168
Name:PAYNE, DAVID HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARVEY
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2373
Mailing Address - Country:US
Mailing Address - Phone:231-876-7880
Mailing Address - Fax:231-876-7160
Practice Address - Street 1:8082 E M 115
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8122
Practice Address - Country:US
Practice Address - Phone:231-876-7880
Practice Address - Fax:231-876-7160
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035126207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2675228Medicaid
08300550112Medicare ID - Type Unspecified
MI2675228Medicaid