Provider Demographics
NPI:1619284759
Name:MAIR, BEVERLY JANE (RD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANE
Last Name:MAIR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21885 DUNHAM RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-469-5200
Mailing Address - Fax:586-469-6364
Practice Address - Street 1:21885 DUNHAM RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1030
Practice Address - Country:US
Practice Address - Phone:586-469-5200
Practice Address - Fax:586-469-6364
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered