Healthcare Provider Details

I. General information

NPI: 1215910252
Provider Name (Legal Business Name): DAVID A. MEHREGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 N MACOMB ST
MONROE MI
48162-3131
US

IV. Provider business mailing address

1314 N MACOMB ST
MONROE MI
48162-3131
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-6872
  • Fax: 734-242-4962
Mailing address:
  • Phone: 734-242-6872
  • Fax: 734-242-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number4301407167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: