Healthcare Provider Details

I. General information

NPI: 1467670216
Provider Name (Legal Business Name): MEGAN ELIZABETH MEADE GLADEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ELIZABETH MEADE

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BARCLAY AVE
PINE RIVER MN
56474-5139
US

IV. Provider business mailing address

1702 UNIVERSITY DR S
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 218-587-4416
  • Fax:
Mailing address:
  • Phone: 701-364-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51115
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: