MEDICARE: DR. JOHN L MEYER DPM

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	213E00000X	Podiatrist	JM000745	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	:	1285620351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN L MEYER DPM

Provider Business Mailing Address
First Line	:	201 S BEACON BLVD
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1947
Country	:	US
Telephone Number	:	616-846-3400
Fax Number	:	616-846-3406

Provider Business Practice Location Address
First Line	:	201 S BEACON BLVD
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-1947
Country	:	US
Telephone Number	:	616-846-3400
Fax Number	:	616-846-3406

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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