Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-114944 | IL |
N | 2081S0010X | Sports Medicine | 036-114944 | IL |
N | 213ES0000X | Sports Medicine | 036-114944 | IL |
NPI | 1568427557 |
---|---|
Provider Name | Steven E. Mayer |
First Address | Warrenville, IL 60555-3845 |
Second Address | Warrenville, IL 60555-3845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 22/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-114944 | (05) | IL |
206147 | MEDICARE GROUP PTAN (01) | IL |
206147174 | MEDICARE INDVIDUAL PTAN (01) | IL |
I52503 | (02) | IL |
P01131078 | RR MEDICARE (01) | IL |