Healthcare Provider Details

I. General information

NPI: 1326149089
Provider Name (Legal Business Name): RYAN L MEREDITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 N MONROE ST
MONROE MI
48162-4254
US

IV. Provider business mailing address

2246 N MONROE ST
MONROE MI
48162-4254
US

V. Phone/Fax

Practice location:
  • Phone: 734-243-0220
  • Fax: 734-243-4269
Mailing address:
  • Phone: 734-243-0220
  • Fax: 734-243-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3501003357
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: