Provider Demographics
NPI:1821067596
Name:MAYER, ERIC AUTY KANOALANI (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:AUTY KANOALANI
Last Name:MAYER
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 1:9500 EUCLID AVE
Mailing Address - Street 2:MAILBOX S40
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-0310
Mailing Address - Fax:216-445-6801
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAILBOX S40
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0310
Practice Address - Fax:216-445-6801
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1913208100000X
OH35-091385208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2961808Medicaid
TX8D8534Medicare ID - Type Unspecified
OH2961808Medicaid