Provider Demographics
NPI:1023010246
Name:MEYER, MARK AMES (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:AMES
Last Name:MEYER
Suffix:
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:1000 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1070
Practice Address - Country:US
Practice Address - Phone:765-472-5335
Practice Address - Fax:765-472-5468
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035273A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000592124OtherANTHEM
IN100344710Medicaid
IN000000738897OtherANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
IN221480007Medicare PIN
IN000000738897OtherANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
INP01008959Medicare PIN
INM400058701Medicare PIN