Provider Demographics
NPI:1770569006
Name:MAYER, MARJORIE H (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:H
Last Name:MAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2308
Mailing Address - Country:US
Mailing Address - Phone:847-446-1829
Mailing Address - Fax:847-446-1118
Practice Address - Street 1:542 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2308
Practice Address - Country:US
Practice Address - Phone:847-446-1829
Practice Address - Fax:847-446-1118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24389Medicare UPIN
912360Medicare ID - Type Unspecified