Provider Demographics
NPI:1396760278
Name:MEILS, LISA A (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MEILS
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 1:155 ROCHDALE DR S
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2276
Mailing Address - Country:US
Mailing Address - Phone:248-608-0360
Mailing Address - Fax:248-608-0362
Practice Address - Street 1:155 ROCHDALE DR S
Practice Address - Street 2:SUITE A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-2276
Practice Address - Country:US
Practice Address - Phone:248-608-0360
Practice Address - Fax:248-608-0362
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051255174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP11550Medicare ID - Type Unspecified
MIE98128Medicare UPIN