Provider Demographics
NPI:1336123793
Name:MAUER, KATHARINE W (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:W
Last Name:MAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 KIRTS BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4851
Mailing Address - Country:US
Mailing Address - Phone:248-269-8529
Mailing Address - Fax:248-269-8566
Practice Address - Street 1:1350 KIRTS BLVD
Practice Address - Street 2:STE 140
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4851
Practice Address - Country:US
Practice Address - Phone:248-269-8529
Practice Address - Fax:248-269-8566
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046375207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2848731Medicaid
E31407Medicare UPIN
0632266Medicare ID - Type Unspecified