Provider Demographics
NPI:1811555139
Name:MAYERS, RAISA AMELIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:AMELIA
Last Name:MAYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18101 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4089
Mailing Address - Country:US
Mailing Address - Phone:313-436-2578
Mailing Address - Fax:313-436-2071
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-436-2578
Practice Address - Fax:313-436-2071
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351044512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine