Provider Demographics
NPI:1215429956
Name:MEERSMAN, AMANDA M (MD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:MEERSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9334
Mailing Address - Country:US
Mailing Address - Phone:574-537-0521
Mailing Address - Fax:574-537-1217
Practice Address - Street 1:851 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9334
Practice Address - Country:US
Practice Address - Phone:574-537-0521
Practice Address - Fax:574-537-1217
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086793A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300014590Medicaid