Healthcare Provider Details

I. General information

NPI: 1467423855
Provider Name (Legal Business Name): CHAD WALTER MAYER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27655 MIDDLEBELT RD STE 100
FARMINGTON HILLS MI
48334-5029
US

IV. Provider business mailing address

7010 PONTIAC TRL SUITE B
WEST BLOOMFIELD MI
48323-2017
US

V. Phone/Fax

Practice location:
  • Phone: 248-363-3232
  • Fax: 248-363-3455
Mailing address:
  • Phone: 248-363-3232
  • Fax: 248-363-3455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101013420
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number5101013420
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: