Healthcare Provider Details

I. General information

NPI: 1346423530
Provider Name (Legal Business Name): BARRY S. MEYER,D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
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: DR. BARRY MEYER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 586-755-5400