Healthcare Provider Details

I. General information

NPI: 1164414074
Provider Name (Legal Business Name): MICHAEL S MEININGER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD SUITE 700
TROY MI
48084-4881
US

IV. Provider business mailing address

1080 KIRTS BLVD SUITE 700
TROY MI
48084-4881
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-2300
  • Fax: 248-362-5272
Mailing address:
  • Phone: 248-362-2300
  • Fax: 248-362-5272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number039869
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMM052764
License Number StateMI

VIII. Authorized Official

Name: MICHAEL SCOTT MEININGER
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 248-362-2300