Provider Demographics
NPI:1407809528
Name:MEEKER, MICHAEL JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MEEKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 REMITTANCE DRIVE
Mailing Address - Street 2:SUITE 6581
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6581
Mailing Address - Country:US
Mailing Address - Phone:708-226-3300
Mailing Address - Fax:708-226-4202
Practice Address - Street 1:10719 WEST 160TH STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5541
Practice Address - Country:US
Practice Address - Phone:708-226-3300
Practice Address - Fax:708-226-4202
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002153363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00143140OtherRAILROAD MEDICARE PROVIDER NUMBER
IL085002153OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER
IL1032380001Medicare NSC
IL085002153OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER