Provider Demographics
NPI:1295930667
Name:MEADOWS, ALLISON DEMARRIS (MD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DEMARRIS
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NILES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3237
Mailing Address - Country:US
Mailing Address - Phone:269-429-5000
Mailing Address - Fax:
Practice Address - Street 1:2500 NILES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-3237
Practice Address - Country:US
Practice Address - Phone:269-429-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine