Provider Demographics
NPI:1790788834
Name:MAYRON, MICHAEL SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:MAYRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 MORNINGSIDE DR.
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420
Mailing Address - Country:US
Mailing Address - Phone:270-860-1982
Mailing Address - Fax:270-830-8332
Practice Address - Street 1:6211 E. WATERFORD BLVD.
Practice Address - Street 2:
Practice Address - City:EVENSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:270-830-9872
Practice Address - Fax:270-830-8332
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-08-24
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
KY344372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64344377Medicaid
KY000000069390OtherKY ANTHEM NUMBER
KYD37261Medicare UPIN
KY1735701Medicare PIN