Provider Demographics
NPI:1639178718
Name:MECCIA, FREDERICK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:MECCIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HENDON WAY STE 1A
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8218
Mailing Address - Country:US
Mailing Address - Phone:800-503-1375
Mailing Address - Fax:866-681-0887
Practice Address - Street 1:2002 HENDON WAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-8218
Practice Address - Country:US
Practice Address - Phone:219-531-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004365213E00000X
IN07000801213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000227516OtherANTHEM BCBS OF INDIANA
IN200045360AMedicaid
IL0060001681OtherBCBS OF ILLINOIS
IN659140Medicare ID - Type Unspecified
IL546200Medicare ID - Type Unspecified