Healthcare Provider Details

I. General information

NPI: 1255379988
Provider Name (Legal Business Name): ROBERT MEEHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MACK AVE FL 5
DETROIT MI
48201-2466
US

IV. Provider business mailing address

23550 PARK ST SUITE 100
DEARBORN MI
48124-2592
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-0500
  • Fax:
Mailing address:
  • Phone: 313-730-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number4301070950
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301070950
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: