Provider Demographics
NPI:1134207574
Name:MAYER, ERIC G (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4100 JOHN R
Practice Address - Street 2:GERSHENSON RADIATION ONCOLOGY CTR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-9640
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI498452085R0001X
MI43010935842085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630655Medicare PIN
D44225Medicare UPIN