Provider Demographics
NPI:1548238850
Name:MCMEEN, VICTORIA M (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:MCMEEN
Suffix:
Gender:F
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:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:519 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4017
Practice Address - Country:US
Practice Address - Phone:920-435-6601
Practice Address - Fax:920-436-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22927208000000X
WI67948-20207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
833515OtherAMERICAN BOARD OF ALLERGY AND IMMUNOLOGY
OK200062410AMedicaid
I45225Medicare UPIN