Provider Demographics
NPI:1851403307
Name:MAYLE, MICHAEL E (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MAYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 PAW PAW AVE
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9519
Mailing Address - Country:US
Mailing Address - Phone:269-463-3600
Mailing Address - Fax:269-463-0013
Practice Address - Street 1:6701 PAW PAW AVE
Practice Address - Street 2:
Practice Address - City:COLOMA
Practice Address - State:MI
Practice Address - Zip Code:49038-9519
Practice Address - Country:US
Practice Address - Phone:269-463-3600
Practice Address - Fax:269-463-0013
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5110003OtherBLUE CROSS BLUE SHIELD PIN
MIMI2051013Medicare PIN
MI5110003OtherBLUE CROSS BLUE SHIELD PIN