Provider Demographics
NPI:1629515853
Name:MEIER, EVAN N (DO)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:N
Last Name:MEIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2448
Mailing Address - Country:US
Mailing Address - Phone:414-423-0555
Mailing Address - Fax:
Practice Address - Street 1:6220 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2448
Practice Address - Country:US
Practice Address - Phone:414-423-0555
Practice Address - Fax:414-423-8268
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine