Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 5101013420 | MI |
N | 208000000X | Pediatrician | 5101013420 | MI |
NPI | 1467423855 |
---|---|
Provider Name | Dr. Chad Walter Mayer |
First Address | West Bloomfield, MI 48323-2017 |
Second Address | Farmington Hills, MI 48334-5029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 28/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H35719 | (02) | MI |