Basic Information
| Provider Information | |||||||||
| NPI: | 1801978986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYOR | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 ARCH ST. SUITE 407 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552986628 | ||||||||
| FaxNumber: | 9034161701 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 ARCH ST. SUITE 407 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303849001 | ||||||||
| FaxNumber: | 9034161701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | J2192 | TX | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 35.130826 | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 0426298 | KS | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | MD453177 | PA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 3581928-01 | 05 | TX | MEDICAID | 102977277 0001 | 05 | PA | MEDICAID | 24951023 | 01 | KS | BCBS OF KANSAS CITY | OTHER | 8FZ417 | 01 | TX | BCBS OF TX | OTHER | 100314130C | 05 | KS | MEDICAID |