Provider Demographics
NPI:1467538231
Name:MERIDEN, TERRY (MD FACP FACN FACE)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:MERIDEN
Suffix:
Gender:M
Credentials:MD FACP FACN FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602
Mailing Address - Country:US
Mailing Address - Phone:309-673-1717
Mailing Address - Fax:309-673-7221
Practice Address - Street 1:900 MAIN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602
Practice Address - Country:US
Practice Address - Phone:309-673-1717
Practice Address - Fax:309-673-7221
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360586021207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058602Medicaid
792111124OtherRAILROAD MEDICARE
IL9000138OtherBCBS
IL9000138OtherBCBS
D93792Medicare UPIN
ILIL6914Medicare PIN