Healthcare Provider Details

I. General information

NPI: 1245294131
Provider Name (Legal Business Name): NICHOLAS ALBERT MEYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N PROSPECT AVE
MILWAUKEE WI
53211-4445
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-319-3000
  • Fax: 414-319-3033
Mailing address:
  • Phone: 414-319-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number32343
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2006001559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: