Healthcare Provider Details

I. General information

NPI: 1518936970
Provider Name (Legal Business Name): SUSAN J MEYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 N PENNSYLVANIA STREET
CARMEL IN
46032-4694
US

IV. Provider business mailing address

PO BOX 2303 DEPT 163
INDIANAPOLIS IN
46206
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-0717
  • Fax: 317-846-0557
Mailing address:
  • Phone: 952-542-8553
  • Fax: 952-513-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01035274A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: