Provider Demographics
NPI:1346293289
Name:MEYROWITZ, MICHAEL R (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:MEYROWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6810 S CEDAR ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-6999
Mailing Address - Country:US
Mailing Address - Phone:517-699-2700
Mailing Address - Fax:517-699-1506
Practice Address - Street 1:6810 S CEDAR ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6999
Practice Address - Country:US
Practice Address - Phone:517-699-2700
Practice Address - Fax:517-699-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM0109821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4062982OtherAETNA
MI4308808OtherPHYSICIANS HEALTH PLAN
MI5331077OtherBLUE CROSS BLUE SHIELD
MI00041091OtherUNITED CONCORDIA
MI5331077OtherBLUE CROSS BLUE SHIELD
MION95870Medicare ID - Type Unspecified