Healthcare Provider Details

I. General information

NPI: 1225486095
Provider Name (Legal Business Name): MEGAN MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4656 TIMBER RIDGE DR
BRUCE TWP MI
48065-4132
US

IV. Provider business mailing address

4656 TIMBER RIDGE DR
BRUCE TWP MI
48065-4132
US

V. Phone/Fax

Practice location:
  • Phone: 586-623-0052
  • Fax:
Mailing address:
  • Phone: 586-623-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: