Provider Demographics
NPI:1346357829
Name:MEVES, RODERICK L (MD)
Entity Type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:L
Last Name:MEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 REDBIRD CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-7977
Mailing Address - Country:US
Mailing Address - Phone:920-338-6870
Mailing Address - Fax:
Practice Address - Street 1:555 REDBIRD CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-7977
Practice Address - Country:US
Practice Address - Phone:920-338-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30606800WIMedicaid
WI30606800Medicaid
AM1718595OtherDEA NUMBER
070100008Medicare PIN
AM1718595OtherDEA NUMBER
WIB55048Medicare UPIN
WI30606800Medicaid
430600031Medicare Oscar/Certification
430800039Medicare Oscar/Certification
WI100200072Medicare Oscar/Certification
WI071700057Medicare Oscar/Certification