Healthcare Provider Details

I. General information

NPI: 1003837915
Provider Name (Legal Business Name): MERIDIAN MEDICAL ASSOCIATES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 GLENWOOD AVE
JOLIET IL
60435-5487
US

IV. Provider business mailing address

2100 GLENWOOD AVE
JOLIET IL
60435-5487
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-2121
  • Fax: 815-741-6303
Mailing address:
  • Phone: 815-999-3000
  • Fax: 805-730-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL COHEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 815-725-2121