Provider Demographics
NPI:1053656298
Name:MEREDITH, ALAN MICHAEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MICHAEL
Last Name:MEREDITH
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:6810 STATE ROUTE 162 BOX 215
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8501
Mailing Address - Country:US
Mailing Address - Phone:618-391-6405
Mailing Address - Fax:618-288-4088
Practice Address - Street 1:6812 STATE ROUTE 162
Practice Address - Street 2:SUITE 21
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-5566
Practice Address - Fax:618-288-4005
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2020-04-07
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Provider Licenses
StateLicense IDTaxonomies
IL085.004538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant