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NPI Code Detail

MEDICARE: DR. FREDERICK GERALD MEOLI DO

MEDICARE: DR. FREDERICK GERALD MEOLI DO
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
12085R0202XDiagnostic Radiology Physician5101015875MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2300F362420OTHERMIBCBSM

General Provider Information

NPI Number : 1225098106
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICK GERALD MEOLI DO
Provider Business Mailing Address
First Line : 49277 FOX DR S
Second Line :
City : PLYMOUTH
State : MI
Zip : 48170-2898
Country : US
Telephone Number : 734-207-1814
Fax Number :
Provider Business Practice Location Address
First Line : 13355 E 10 MILE RD
Second Line : RADIOLOGY DEPARTMENT DR. MEOLI
City : WARREN
State : MI
Zip : 48089-2048
Country : US
Telephone Number : 586-759-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 11/16/2007

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