Provider Demographics
NPI:1184810608
Name:MEYER FAMILY MEDICINE ASSOCIATES LLC
Entity type:Organization
Organization Name:MEYER FAMILY MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-966-9878
Mailing Address - Street 1:7900 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 2-23
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3159
Mailing Address - Country:US
Mailing Address - Phone:847-966-9878
Mailing Address - Fax:847-213-2057
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-23
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-966-9878
Practice Address - Fax:847-213-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623900OtherBLUE CROSS & BLUE SHIELD OF ILLINOIS
IL036092039Medicaid
IL036098934Medicaid
IL01623900OtherBLUE CROSS & BLUE SHIELD OF ILLINOIS