Provider Demographics
NPI:1720052517
Name:MEYER, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:1607 STATE ROUTE 60
Practice Address - Street 2:STE 6
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089
Practice Address - Country:US
Practice Address - Phone:440-967-8713
Practice Address - Fax:440-967-1938
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OH0482295Medicaid
OH3025372Medicaid
OH0448332Medicare ID - Type Unspecified
OH0448333Medicare PIN
OH3025372Medicaid
A77598Medicare UPIN
OH9389631Medicare PIN