Individual
THEODORE G. MAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-9106
(313) 916-1249
Mailing address
HENRY FORD HEALTH SYSTEM, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202
(313) 916-9106
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
4301089187
MI
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301089187
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H262270
BLUE CROSS-BLUE CROSS
—
05
—
888888810
—
MI
01
—
TM089187
CHAMPUS-CHAMPUS
—
Enumeration date
08/02/2006
Last updated
09/12/2016
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