Provider Demographics
NPI:1912999012
Name:AUGUSTYNIAK, WAYNE GERARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:GERARD
Last Name:AUGUSTYNIAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2889 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2123
Mailing Address - Country:US
Mailing Address - Phone:269-343-1247
Mailing Address - Fax:269-343-6661
Practice Address - Street 1:2889 SOUTH 11TH STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2123
Practice Address - Country:US
Practice Address - Phone:269-343-1247
Practice Address - Fax:269-343-6661
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601001009OtherSTATE LICENCE NUMBER
MIC96066P01Medicare ID - Type Unspecified
MI5601001009OtherSTATE LICENCE NUMBER