MEDICARE: SHANNON S 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	213ES0103X	Foot & Ankle Surgery Podiatrist	726-25	WI
2	213E00000X	Podiatrist	726-25	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG4176	OTHER		RAILROAD MEDICARE

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	:	1316933542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON S MEYER DPM

Provider Business Mailing Address
First Line	:	7428 LOON LANDING SHORES
Second Line	:
City	:	LAKE TOMAHAWK
State	:	WI
Zip	:	54539-9110
Country	:	US
Telephone Number	:	877-265-5225
Fax Number	:	715-277-4944

Provider Business Practice Location Address
First Line	:	311 ELM ST
Second Line	:
City	:	WOODRUFF
State	:	WI
Zip	:	54568-9149
Country	:	US
Telephone Number	:	715-634-9023
Fax Number	:	715-634-9935

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	08/23/2017

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Directions to “ SHANNON S MEYER DPM” Practice Location

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