Basic Information
| Provider Information | |||||||||
| NPI: | 1801955588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEKJIAN | ||||||||
| FirstName: | JOHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7203 RIVER RIDGE CT | ||||||||
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| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481167771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347653171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1048 N. MONROE ST | ||||||||
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| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342411400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501004378 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.