Healthcare Provider Details

I. General information

NPI: 1376941229
Provider Name (Legal Business Name): DANIEL PATRICK MEYER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15075 CIMARRON AVE
ROSEMOUNT MN
55068-1635
US

IV. Provider business mailing address

3746 N HERMITAGE AVE # 1
CHICAGO IL
60613-3509
US

V. Phone/Fax

Practice location:
  • Phone: 651-322-8800
  • Fax:
Mailing address:
  • Phone: 608-345-3451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: