Provider Demographics
NPI:1487703047
Name:MEYER, RICHARD T JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:MEYER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 S SCHMALE RD
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2756
Mailing Address - Country:US
Mailing Address - Phone:630-668-9610
Mailing Address - Fax:630-668-9813
Practice Address - Street 1:389 S SCHMALE RD
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2756
Practice Address - Country:US
Practice Address - Phone:630-668-9610
Practice Address - Fax:630-668-9813
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057308207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057308Medicaid
ILD93392Medicare UPIN
IL036057308Medicaid