Healthcare Provider Details

I. General information

NPI: 1306863014
Provider Name (Legal Business Name): TODD ANDREW MEYER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S MADISON ST
APPLETON WI
54915-1846
US

IV. Provider business mailing address

119 E BELL ST
NEENAH WI
54956-4993
US

V. Phone/Fax

Practice location:
  • Phone: 920-730-4443
  • Fax:
Mailing address:
  • Phone: 757-636-2923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101013421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: