Provider Demographics
NPI:1366591828
Name:MEYKA, DANIELLE MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIE
Last Name:MEYKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:MEYKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 2335
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48844-2335
Mailing Address - Country:US
Mailing Address - Phone:517-304-4773
Mailing Address - Fax:517-552-7402
Practice Address - Street 1:524 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1410
Practice Address - Country:US
Practice Address - Phone:517-548-3100
Practice Address - Fax:517-548-4594
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002042213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11283633OtherCAQH
MI5901002042OtherLICENSE
MIBM8323898OtherDEA