Healthcare Provider Details

I. General information

NPI: 1730384306
Provider Name (Legal Business Name): MEREDITH ANN WOOD P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR SUITE 450
ROCHESTER HILLS MI
48307-1871
US

IV. Provider business mailing address

4567 BURNLEY DR
BLOOMFIELD HILLS MI
48304-3718
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-2400
  • Fax: 248-650-4596
Mailing address:
  • Phone: 248-650-2400
  • Fax: 248-650-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601003156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: