Healthcare Provider Details

I. General information

NPI: 1083675979
Provider Name (Legal Business Name): MICHAEL THOMAS MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE # 681
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # 681
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-3360
  • Fax: 414-266-3563
Mailing address:
  • Phone: 414-266-3360
  • Fax: 414-266-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number39765-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: