Healthcare Provider Details

I. General information

NPI: 1225098106
Provider Name (Legal Business Name): FREDERICK GERALD MEOLI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD RADIOLOGY DEPARTMENT DR. MEOLI
WARREN MI
48089-2048
US

IV. Provider business mailing address

49277 FOX DR S
PLYMOUTH MI
48170-2898
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7300
  • Fax:
Mailing address:
  • Phone: 734-207-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101015875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: