Provider Demographics
NPI:1801978986
Name:MAYOR, KEVIN LEE (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:LEE
Last Name:MAYOR
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 1:75 ARCH ST. SUITE 407
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304
Mailing Address - Country:US
Mailing Address - Phone:855-298-6628
Mailing Address - Fax:903-416-1701
Practice Address - Street 1:75 ARCH ST. SUITE 407
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304
Practice Address - Country:US
Practice Address - Phone:330-384-9001
Practice Address - Fax:903-416-1701
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2192208G00000X
OH35.130826208G00000X
KS0426298208G00000X
PAMD453177208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3581928-01Medicaid
PA102977277 0001Medicaid
KS24951023OtherBCBS OF KANSAS CITY
TX8FZ417OtherBCBS OF TX
KS100314130CMedicaid
TX8FZ417OtherBCBS OF TX
KSS130000Medicare ID - Type UnspecifiedGROUP
PA102977277 0001Medicaid
KS24951023OtherBCBS OF KANSAS CITY