Provider Demographics
NPI:1427208677
Name:POPP, MEGAN M (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:POPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1180 CHANDLER DR
Mailing Address - Street 2:ESSENTIA HEALTH SPOONER CLINIC
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801-2204
Mailing Address - Country:US
Mailing Address - Phone:715-635-2151
Mailing Address - Fax:
Practice Address - Street 1:707 ASH ST
Practice Address - Street 2:ESSENTIA HEALTH SPOONER CLINIC
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1234
Practice Address - Country:US
Practice Address - Phone:715-635-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI60559-20208100000X
MN51236208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1427208677Medicaid
MN1427208677Medicaid
MI1427208677Medicaid
WIK400093933 - SPOONERMedicare PIN