Nutrigenomic Medicine PC

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

5101007821 Issued in MI

Legal business name

NUTRIGENOMIC MEDICINE PC

Practice address

19229 Mack Ave
Grosse Pointe Woods, MI 48236-2858

Phone

(313) 647-3320

NPI assigned

Nov 28, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Meulendyk, D.O.NPI 1275559775

Title

Owner

Phone

(248) 335-3134

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Meulendyk, DO

  • Public Health & General Preventive Medicine Physician
  • Bloomfield, MI
  • NPI 1275559775
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1295917649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1983 KEMP RD",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "483020142",
            "telephone_number": "248-335-3134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19229 MACK AVE",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482362858",
            "telephone_number": "313-647-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRIGENOMIC MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "MEULENDYK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-335-3134",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "MI",
            "license": "5101007821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4802974",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nformed Care LLC
• Nformed Care LLC
• Glady Nguyen
• Cree Charnle Nichols
• Kelah Deonshae Nobles
• Chioma Nweke, PHARMD
• Melissa Ann O'Keefe, CCC-SLP
• Robert M Obryan, M.D.
• Daniel Matthew Ockner, MD
• Office 6 PLLC

• Public Health & General Preventive Medicine Physician in Grosse Pointe Woods, MI
• Providers in Grosse Pointe Woods, MI by specialty
• Public Health & General Preventive Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.