Provider Demographics
NPI:1013116672
Name:MEERSCHAERT, MARY CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CARMEN
Last Name:MEERSCHAERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:CARMEN
Other - Last Name:MEERSCHAERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5135 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4002
Mailing Address - Country:US
Mailing Address - Phone:517-887-5922
Mailing Address - Fax:517-887-5982
Practice Address - Street 1:790 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1387
Practice Address - Country:US
Practice Address - Phone:517-244-0120
Practice Address - Fax:517-244-0163
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013116672Medicaid
MIC36082103Medicare PIN
B46129Medicare UPIN
MI1013116672Medicaid
MI0C36082Medicare PIN