Individual
MEAGHAN REBECCA SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22250 PROVIDENCE DRIVE, 7PMB SUITE #703A, SOUTHFIELD, MI 48075
(248) 849-5862
Mailing address
3811 PARDEE AVE, DEARBORN, MI 48124-3569
(248) 372-1712
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4351048714
MI
Other
Enumeration date
06/16/2021
Last updated
06/16/2021
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