Individual
THERESA MAYHARTLE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
12805 ESCANABA DR, SUITE 2, DEWITT, MI 48820-8628
(517) 367-5520
(517) 367-5521
Mailing address
401 S BALLENGER HWY, FLINT, MI 48532-3638
(810) 342-1000
(810) 342-1590
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101011364
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01795
AETNA
MI
01
—
0700186
PHYSICIANS HEALTH PLAN
MI
01
—
1651913484
BLUE CROSS BLUE SHIELD
MI
01
—
252503
HEALTH ADVANTAGE NETWORK
MI
05
—
4154702
—
MI
01
—
G10710
HEALTH NET FEDERAL SERVIC
MI
Enumeration date
01/20/2006
Last updated
07/08/2007
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