Provider Demographics
NPI:1073506903
Name:MEKARU, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:MEKARU
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 1:650 LINDEN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1879
Mailing Address - Country:US
Mailing Address - Phone:231-796-4470
Mailing Address - Fax:231-796-1605
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-4470
Practice Address - Fax:231-796-1605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3257447Medicaid
MIOM93630Medicare UPIN