Provider Demographics
NPI:1144778010
Name:MEEHAN, WARREN
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 HURON CT
Mailing Address - Street 2:APT. 307
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2387
Mailing Address - Country:US
Mailing Address - Phone:845-821-1144
Mailing Address - Fax:
Practice Address - Street 1:3008 HURON CT
Practice Address - Street 2:APT. 307
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-2387
Practice Address - Country:US
Practice Address - Phone:845-821-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other