Provider Demographics
NPI:1891707907
Name:DR DAN MAYER INC
Entity Type:Organization
Organization Name:DR DAN MAYER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-333-4383
Mailing Address - Street 1:PO BOX 45525
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0525
Mailing Address - Country:US
Mailing Address - Phone:440-808-3700
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-4383
Practice Address - Fax:440-333-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338501Medicare ID - Type UnspecifiedGROUP NUMBER