Healthcare Provider Details

I. General information

NPI: 1679501290
Provider Name (Legal Business Name): PATRICK J MEYER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE STE 100
GRAND RAPIDS MI
49546-6117
US

IV. Provider business mailing address

2144 E. PARIS AVE SE STE 100
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-0666
  • Fax: 616-281-0752
Mailing address:
  • Phone: 616-281-0666
  • Fax: 616-281-0752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901001847
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: