Provider Demographics
NPI:1467423855
Name:MAYER, CHAD WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WALTER
Last Name:MAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7010 PONTIAC TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2017
Mailing Address - Country:US
Mailing Address - Phone:248-363-3232
Mailing Address - Fax:248-363-3455
Practice Address - Street 1:27655 MIDDLEBELT RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5029
Practice Address - Country:US
Practice Address - Phone:248-363-3232
Practice Address - Fax:248-363-3455
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013420208000000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH35719Medicare UPIN
MIP3393001Medicare ID - Type Unspecified