MEDICARE: MARJORIE H MAYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician		IL

General Provider Information

NPI Number	:	1770569006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE H MAYER MD

Provider Business Mailing Address
First Line	:	542 LINCOLN AVE
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-2308
Country	:	US
Telephone Number	:	847-446-1829
Fax Number	:	847-446-1118

Provider Business Practice Location Address
First Line	:	542 LINCOLN AVE
Second Line	:
City	:	WINNETKA
State	:	IL
Zip	:	60093-2308
Country	:	US
Telephone Number	:	847-446-1829
Fax Number	:	847-446-1118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/08/2007

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