Provider Demographics
NPI:1871648212
Name:RONALD LEE MEYERS, D.O.
Entity Type:Organization
Organization Name:RONALD LEE MEYERS, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-754-4700
Mailing Address - Street 1:55 E LONG LAKE RD
Mailing Address - Street 2:PMB #104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30050 HOOVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2544
Practice Address - Country:US
Practice Address - Phone:586-754-4700
Practice Address - Fax:586-757-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM15101 007089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080E0 22000OtherBCBS-MI
MI080E0 22000OtherBCBS-MI
MIAM8806094OtherDEA NUMBER
MI080E0 22000OtherBCBS-MI