Provider Demographics
NPI:1073840799
Name:MEANEY, MICHAEL PATRICK (APN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MEANEY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:SOMONAUK
Mailing Address - State:IL
Mailing Address - Zip Code:60552-9632
Mailing Address - Country:US
Mailing Address - Phone:630-995-5536
Mailing Address - Fax:
Practice Address - Street 1:14601 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2641
Practice Address - Country:US
Practice Address - Phone:708-349-8300
Practice Address - Fax:708-349-4309
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007899363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology