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General NPI Number Information
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NPI Number | 1225098106
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Entity Type | Individual
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Provider Name | FREDERICK GERALD MEOLI DO
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 13355 E 10 MILE RD RADIOLOGY DEPARTMENT DR. MEOLI
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City | WARREN
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State | MI
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Zip | 48089-2048
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Country | US
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Telephone | 586-759-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 49277 FOX DR S
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City | PLYMOUTH
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State | MI
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Zip | 48170-2898
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Country | US
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Telephone | 734-207-1814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 5101015875
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License Number State | MI
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