Individual
MEGAN MARIE EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1200 56TH ST SW, C/O BROOKVILLE PEDIATRIC & INTERNAL MEDICINE, PC, WYOMING, MI 49509-9704
(616) 243-5707
(616) 243-1170
Mailing address
8485 ALGOMA AVE, C/O BROOKVILLE PEDIATRIC & INTERNAL MEDICINE, PC, ROCKFORD, MI 49341
(616) 243-5707
(616) 243-1170
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301086893
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11108809
CAQH #
MI
Enumeration date
02/11/2006
Last updated
12/17/2007
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