Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036140519 | IL |
N | 207P00000X | Emergency Physician | 4301104552 | MI |
N | 207PP0204X | Pediatric Emergency Physician | 4301104552 | MI |
NPI | 1023308418 |
---|---|
Provider Name | Dr. Kurtis Alexander Mayz |
First Address | Plainfield, IL 60585-2989 |
Second Address | Joliet, IL 60435-8200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 02/11/2018 |