Provider Demographics
NPI:1922265305
Name:MEYER, ERIN MARIE (DO)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARIE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5775 STONEBRIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3240
Mailing Address - Country:US
Mailing Address - Phone:570-951-9033
Mailing Address - Fax:
Practice Address - Street 1:5775 STONEBRIDGE DR SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418
Practice Address - Country:US
Practice Address - Phone:570-951-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1017-321207R00000X
MS29005207R00000X
IADO-05698207R00000X
ALDO.2454207R00000X
DEC2-0009110208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922265305OtherNPI
MS29005OtherMS LICENSE
AL2454OtherAL LICENSE