Provider Demographics
NPI:1285620351
Name:MEYER, JOHN L (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:MEYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1947
Mailing Address - Country:US
Mailing Address - Phone:616-846-3400
Mailing Address - Fax:616-846-3406
Practice Address - Street 1:201 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1947
Practice Address - Country:US
Practice Address - Phone:616-846-3400
Practice Address - Fax:616-846-3406
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJM000745213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2105899Medicaid
MI2105899Medicaid