MEDICARE: JOHN GOTTFRIED 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	207X00000X	Orthopaedic Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04915144	OTHER	IL	BCBS OF ILLINOIS

General Provider Information

NPI Number	:	1194716985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GOTTFRIED MAYER MD

Provider Business Mailing Address
First Line	:	105 N GREENLEAF ST
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3326
Country	:	US
Telephone Number	:	847-623-3090
Fax Number	:	847-623-9620

Provider Business Practice Location Address
First Line	:	105 N GREENLEAF ST
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-3326
Country	:	US
Telephone Number	:	847-623-3090
Fax Number	:	847-623-9620

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	03/11/2008

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