Provider Demographics
NPI:1144494584
Name:NAGAMINE, WAYDE HITOSHI (MD)
Entity type:Individual
Prefix:
First Name:WAYDE
Middle Name:HITOSHI
Last Name:NAGAMINE
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 1:3249 OAK PARK AVE
Mailing Address - Street 2:METROPOLITAN ADVANCED RADIOLOGICAL SERVICES
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3429
Mailing Address - Country:US
Mailing Address - Phone:708-783-2696
Mailing Address - Fax:708-783-3164
Practice Address - Street 1:3249 OAK PARK AVE
Practice Address - Street 2:METROPOLITAN ADVANCED RADIOLOGICAL SERVICES
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3429
Practice Address - Country:US
Practice Address - Phone:708-783-2696
Practice Address - Fax:708-783-3164
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1161272085N0700X
OH0933762085R0202X
NV130052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116127Medicaid
IL036116127Medicaid