MEDICARE: ROBERT MEEHAN 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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	4301070950	MI
2	207X00000X	Orthopaedic Surgery Physician	4301070950	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1255379988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MEEHAN MD

Provider Business Mailing Address
First Line	:	23550 PARK ST
Second Line	:	SUITE 100
City	:	DEARBORN
State	:	MI
Zip	:	48124-2592
Country	:	US
Telephone Number	:	313-730-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MACK AVE FL 5
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2466
Country	:	US
Telephone Number	:	313-832-0500
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/12/2019

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