Healthcare Provider Details

I. General information

NPI: 1235139619
Provider Name (Legal Business Name): PAUL ANTHONY MEYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 N MILWAUKEE AVE OAK MILL MALL SUITE 2-23
NILES IL
60714-3159
US

IV. Provider business mailing address

7900 N MILWAUKEE AVE OAK MILL MALL SUITE 2-23
NILES IL
60714-3159
US

V. Phone/Fax

Practice location:
  • Phone: 847-966-9878
  • Fax: 847-213-2057
Mailing address:
  • Phone: 847-966-9878
  • Fax: 847-213-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-092039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: