Individual
KELLY M MEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
740 DEERWOOD AVE, NEENAH, WI 54956
(920) 751-9600
Mailing address
740 DEERWOOD AVE, NEENAH, WI 54956
(920) 751-9600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0102201356
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100864
ANTHEM PROVIDER NUMBER
VA
01
—
39739
OPTIMA HEALTH PROVIDER NO
VA
Enumeration date
12/02/2005
Last updated
07/08/2007
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