Healthcare Provider Details

I. General information

NPI: 1194706580
Provider Name (Legal Business Name): BARRY S MEYER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23423 RYAN RD
WARREN MI
48091-1927
US

IV. Provider business mailing address

23423 RYAN RD
WARREN MI
48091-1927
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-5400
  • Fax: 586-755-0066
Mailing address:
  • Phone: 586-755-5400
  • Fax: 586-755-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101011427
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: