MEDICARE: DR. MICHAEL JOHN MEYER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-098934	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-098934	OTHER	IL	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1043219322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN MEYER D.O.

Provider Business Mailing Address
First Line	:	7900 N MILWAUKEE AVE
Second Line	:	SUITE 2-23
City	:	NILES
State	:	IL
Zip	:	60714-3159
Country	:	US
Telephone Number	:	847-966-9878
Fax Number	:	847-213-2057

Provider Business Practice Location Address
First Line	:	7900 N MILWAUKEE AVE
Second Line	:	SUITE 2-23
City	:	NILES
State	:	IL
Zip	:	60714-3159
Country	:	US
Telephone Number	:	847-966-9878
Fax Number	:	847-213-2057

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/31/2021

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