Healthcare Provider Details

I. General information

NPI: 1790574234
Provider Name (Legal Business Name): MEGAN WATSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39901 TRADITIONS DR FL 2
NORTHVILLE MI
48168-9493
US

IV. Provider business mailing address

1200 E HOSPITAL DR D3230
ANN ARBOR MI
48109
US

V. Phone/Fax

Practice location:
  • Phone: 734-539-5080
  • Fax:
Mailing address:
  • Phone: 734-647-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5151017418
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: