Provider Demographics
NPI:1083836043
Name:MEYER, IAN A (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:A
Last Name:MEYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 PINE ROAD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236
Mailing Address - Country:US
Mailing Address - Phone:513-841-0222
Mailing Address - Fax:513-841-0638
Practice Address - Street 1:8251 PINE ROAD
Practice Address - Street 2:SUITE 212
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236
Practice Address - Country:US
Practice Address - Phone:513-841-0222
Practice Address - Fax:513-841-0638
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008568207RN0300X
OH34.008568207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2605694Medicaid
OH2605694Medicaid