Provider Demographics
NPI:1518173137
Name:MEER DEEN DPM PC
Entity Type:Organization
Organization Name:MEER DEEN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-356-5900
Mailing Address - Street 1:PO BOX 38005
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-0005
Mailing Address - Country:US
Mailing Address - Phone:248-356-5900
Mailing Address - Fax:
Practice Address - Street 1:24060 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-3904
Practice Address - Country:US
Practice Address - Phone:248-356-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMD001057213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI13-4740844Medicaid
MI4856313260OtherBLUE CROSS
MI4856313260OtherBLUE CROSS
MI4856313260OtherBLUE CROSS
MI=========OtherTAX ID