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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Ethan H. Hamilton Justin Wayne Wayne Wayne | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Ethan H. Hamilton Justin | [sources] | |||
| Last name | Wayne Wayne Wayne | [sources] | |||
| NPI | 1770980062 | [sources] | |||
| Sector | Laboratory | [sources] | |||
| Address | Palm Beach Gardens FL, MI | [sources] | |||
| Last change | Last processed | First seen | |||
Providers who have been terminated for cause from Michigan's Medicaid program.
United States of America · MDHHS
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States | Michigan Department of Health & Human Services | - | |||
| Linked to | ||||
|---|---|---|---|---|
| Object | Role | Start date | End date | |
| SMART LAB Debarred entity | - | - | - | |