Carlson, Wayne Bruce

Carlson, Wayne Bruce is an individual health care provider with primary practice located at 901 Lakeshore Dr , Ishpeming MI 49849-1367. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Carlson, Wayne Bruce can be contacted via phone (906) 485-2687.

Contact Information

Primary practice address
901 Lakeshore Dr Ishpeming MI 49849-1367
Phone: (906) 485-2687
Fax: (906) 485-2730
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 4301044847 Michigan
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 4301044847 Michigan

Profile Details

NPI number 1790846335
LBN Legal business name Carlson, Wayne Bruce
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2006
Last updated Dec 10th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790846335 NPPES
Michigan MEDICAID 103306407
Michigan Other 080E21007
Michigan Other WC044847

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