Healthcare Provider Details

I. General information

NPI: 1235556424
Provider Name (Legal Business Name): SHIRLEY MEYERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHIRLEY BOCHMAN

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 800-653-6568
  • Fax: 313-876-1305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301500196
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4301500196
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: