Provider Demographics
NPI:1215928916
Name:CASE, WAYNE H (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3410 W 84TH ST
Mailing Address - Street 2:BLDG F SUITE 110
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:305-558-3571
Mailing Address - Fax:305-558-3682
Practice Address - Street 1:3410 W 84TH ST
Practice Address - Street 2:BLDG F SUITE 110
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:305-558-3571
Practice Address - Fax:305-558-3682
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0019774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054669100Medicaid
FL054669100Medicaid
D59767Medicare UPIN
FL91689ZMedicare PIN