Provider Demographics
NPI:1083759617
Name:MEYERS, KEDERICK A (PAC)
Entity Type:Individual
Prefix:MR
First Name:KEDERICK
Middle Name:A
Last Name:MEYERS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 N MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240
Mailing Address - Country:US
Mailing Address - Phone:812-663-7277
Mailing Address - Fax:812-662-7307
Practice Address - Street 1:955 N MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240
Practice Address - Country:US
Practice Address - Phone:812-663-7277
Practice Address - Fax:812-662-7307
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine