Individual
MARIO JC DE MEIRELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23874 KEAN ST, DEARBORN, MI 48124-1851
(313) 359-0801
(313) 359-2674
Mailing address
26850 PROVIDENCE PARKWAY, PMOB#200, NOVI, MI 48374
(248) 465-3144
(248) 465-3146
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301061758
MI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301061758
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3326713 10
—
MI
Enumeration date
06/09/2005
Last updated
03/31/2020
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