MEDICARE: MR. WILLIAM ROBERT MEERMANS JR. PHD

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	103T00000X	Psychologist	6801007002	MI

General Provider Information

NPI Number	:	1780780734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ROBERT MEERMANS JR. PHD

Provider Business Mailing Address
First Line	:	415 W GRAND RIVER AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4201
Country	:	US
Telephone Number	:	517-351-1234
Fax Number	:	517-333-8777

Provider Business Practice Location Address
First Line	:	415 W GRAND RIVER AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4201
Country	:	US
Telephone Number	:	517-351-1234
Fax Number	:	517-333-8777

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	10/30/2015

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