Healthcare Provider Details

I. General information

NPI: 1639687338
Provider Name (Legal Business Name): ALEX MEIRIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S WOLF RD
WHEELING IL
60090-4843
US

IV. Provider business mailing address

221 S WOLF RD
WHEELING IL
60090-4843
US

V. Phone/Fax

Practice location:
  • Phone: 847-520-2774
  • Fax:
Mailing address:
  • Phone: 847-520-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number696066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: