MEDICARE: DR. DUANE GEORGE MAYHEW 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	207Y00000X	Otolaryngology Physician	4301050440	MI

General Provider Information

NPI Number	:	1437310976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUANE GEORGE MAYHEW MD

Provider Business Mailing Address
First Line	:	1072 APPLEGATE LN
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2118
Country	:	US
Telephone Number	:	517-351-5055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1072 APPLEGATE LN
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2118
Country	:	US
Telephone Number	:	517-351-5055
Fax Number	:

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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