Provider Demographics
NPI:1700875747
Name:MEYER, RICKY ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:ALLEN
Last Name:MEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2794
Mailing Address - Fax:989-583-2829
Practice Address - Street 1:1320 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4751
Practice Address - Country:US
Practice Address - Phone:989-583-7460
Practice Address - Fax:989-583-7432
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87420207RG0100X
OH35.065182207RG0100X
IN01044094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100007345OtherRAILROAD MEDICARE
IN000000638375OtherANTHEM
OH0931424Medicaid
IN000000084165OtherBCBS PROVIDER NUMBER
MI1700875747Medicaid
IN4137314OtherAETNA PROVIDER NUMBER
IN200033480Medicaid
IN7927894001OtherCIGNA PROVIDER NUMBER
MI1700875747Medicaid
IN000000638375OtherANTHEM
MIM74750410Medicare PIN