Healthcare Provider Details

I. General information

NPI: 1851403307
Provider Name (Legal Business Name): MICHAEL E MAYLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 PAW PAW AVE
COLOMA MI
49038-9519
US

IV. Provider business mailing address

6701 PAW PAW AVE
COLOMA MI
49038-9519
US

V. Phone/Fax

Practice location:
  • Phone: 269-463-3600
  • Fax: 269-463-0013
Mailing address:
  • Phone: 269-463-3600
  • Fax: 269-463-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009859
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: