Healthcare Provider Details

I. General information

NPI: 1588094072
Provider Name (Legal Business Name): JOAN MEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 N HIGHLAND AVE
ARLINGTON HEIGHTS IL
60004-5513
US

IV. Provider business mailing address

623 N HIGHLAND AVE
ARLINGTON HEIGHTS IL
60004-5513
US

V. Phone/Fax

Practice location:
  • Phone: 847-606-1461
  • Fax:
Mailing address:
  • Phone: 847-606-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036035822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: