MEDICARE: MARYJO MEIER M.D.

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	208000000X	Pediatrics Physician	01054386A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1102438797	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386683522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYJO MEIER M.D.

Provider Business Mailing Address
First Line	:	707 CEDAR ST STE 405
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46617-2059
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0741

Provider Business Practice Location Address
First Line	:	611 E DOUGLAS RD STE 401
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1468
Country	:	US
Telephone Number	:	574-335-6242
Fax Number	:	574-335-0758

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	02/19/2024

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