Healthcare Provider Details

I. General information

NPI: 1548388929
Provider Name (Legal Business Name): MIKEL R. MEYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 GLENDALE AVE
SPARKS NV
89431-5775
US

IV. Provider business mailing address

3285 TRUMPETER CT
RENO NV
89509-3935
US

V. Phone/Fax

Practice location:
  • Phone: 775-356-8181
  • Fax: 775-332-8085
Mailing address:
  • Phone: 775-356-8181
  • Fax: 775-827-6947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberNV1869
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: