Provider Demographics
NPI:1811004849
Name:MAURER, JOHN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:MAURER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 WEALTHY ST SE
Mailing Address - Street 2:STE 150
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2969
Mailing Address - Country:US
Mailing Address - Phone:616-459-3158
Mailing Address - Fax:616-459-4714
Practice Address - Street 1:1900 WEALTHY ST SE
Practice Address - Street 2:STE 150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2969
Practice Address - Country:US
Practice Address - Phone:616-459-3158
Practice Address - Fax:616-459-4714
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-2145264OtherIRS TAX ID# THRU CORP
MI1104102331OtherBCBS OF MICHIGAN
MI1432468Medicaid
B44989Medicare UPIN
MI1432468Medicaid