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General NPI Number Information
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NPI Number | 1003837915
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Entity Type | Organization
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Legal Business Name | MERIDIAN MEDICAL ASSOCIATES, SC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 2100 GLENWOOD AVE
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City | JOLIET
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State | IL
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Zip | 60435-5487
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Country | US
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Telephone | 815-725-2121
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Fax | 815-741-6303
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Provider Business Mailing Address
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Address Line | 2100 GLENWOOD AVE
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City | JOLIET
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State | IL
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Zip | 60435-5487
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Country | US
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Telephone | 815-999-3000
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Fax | 805-730-6343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL COHEN
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Credential | M.D.
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Telephone | 815-725-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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