Provider Demographics
NPI:1710540661
Name:FLEESE, MEGAN MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:FLEESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:GLAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6401 PRAIRIE ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7843
Mailing Address - Country:US
Mailing Address - Phone:231-672-7939
Mailing Address - Fax:231-727-7935
Practice Address - Street 1:6401 PRAIRIE ST STE 1700
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7843
Practice Address - Country:US
Practice Address - Phone:231-672-7939
Practice Address - Fax:231-727-7935
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027442207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology