Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301097306 | MI |
NPI | 1033446547 |
---|---|
Provider Name | Ross Mayerhoff |
First Address | Troy, MI 48083-1138 |
Second Address | Troy, MI 48083-1138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2009 |
Last Update Date | 31/07/2015 |