Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4301068524 | MI |
NPI | 1003840778 |
---|---|
Provider Name | Dr. Ruth Evans Mays |
First Address | Highland Park, MI 48203-3794 |
Second Address | Highland Park, MI 48203-3794 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18471 | (02) | MI |