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General NPI Number Information
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NPI Number | 1659726131
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Entity Type | Individual
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Provider Name | TODD LAMONT MERRIWETHER SR.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 05/03/2016
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Provider Practice Location Address
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Address Line | 263 N WALNUT ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5813
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Country | US
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Telephone | 586-339-4572
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Fax |
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Provider Business Mailing Address
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Address Line | 263 N WALNUT ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5813
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Country | US
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Telephone | 586-339-4572
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | M636799488835
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License Number State | MI
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