Provider Demographics
NPI:1225098106
Name:MEOLI, FREDERICK GERALD (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:GERALD
Last Name:MEOLI
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 1:49277 FOX DR S
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2898
Mailing Address - Country:US
Mailing Address - Phone:734-207-1814
Mailing Address - Fax:
Practice Address - Street 1:13355 E 10 MILE RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT DR. MEOLI
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2048
Practice Address - Country:US
Practice Address - Phone:586-759-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010158752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4766626Medicaid
MI300F362420OtherBCBSM
MII32689Medicare UPIN
MI4766626Medicaid