Provider Demographics
NPI:1730384306
Name:WOOD, MEREDITH ANN (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4567 BURNLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3718
Mailing Address - Country:US
Mailing Address - Phone:248-650-2400
Mailing Address - Fax:248-650-4596
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 450
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-650-2400
Practice Address - Fax:248-650-4596
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2014-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003156363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00323189OtherMEDICARE RAILROAD
MIP00323189OtherMEDICARE RAILROAD
MIS88853Medicare UPIN