Provider Demographics
NPI:1780601633
Name:DERRIG, MERIDITH ANN LOE (MD)
Entity type:Individual
Prefix:
First Name:MERIDITH
Middle Name:ANN LOE
Last Name:DERRIG
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 1:205 MUIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53153-9618
Mailing Address - Country:US
Mailing Address - Phone:262-392-3994
Mailing Address - Fax:
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology