Individual
JOHN RAYMOND MAURER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1900 WEALTHY ST SE, STE 150, GRAND RAPIDS, MI 49506-2969
(616) 459-3158
(616) 459-4714
Mailing address
1900 WEALTHY ST SE, STE 150, GRAND RAPIDS, MI 49506-2969
(616) 459-3158
(616) 459-4714
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301043562
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104102331
BCBS OF MICHIGAN
MI
05
—
1432468
—
MI
01
—
38-2145264
IRS TAX ID# THRU CORP
—
Enumeration date
08/24/2006
Last updated
06/22/2010
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