Provider Demographics
NPI:1053499038
Name:MAYER, THOMAS MILTON (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MILTON
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-781-4900
Mailing Address - Fax:859-572-3044
Practice Address - Street 1:40 N GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4107
Practice Address - Country:US
Practice Address - Phone:859-781-4900
Practice Address - Fax:859-572-3044
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19493207Y00000X, 207YP0228X, 207YX0602X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65917965Medicaid
IN1046545OtherIN MEDICAL LICENSE
KY64194939Medicaid
000000033776OtherANTHEM
IN100015770Medicaid
4044101OtherAETNA
OH701333Medicaid
OH701342Medicaid
10-20163OtherUNITED HEALTHCARE
1094OtherCHA
KY19493OtherKY MEDICAL LICENSE
OH35033598OtherOH MEDICAL LICENSE
IN100015770Medicaid
4044101OtherAETNA
000000033776OtherANTHEM
KY2168Medicare ID - Type UnspecifiedKY GROUP NUMBER