Provider Demographics
NPI:1144277625
Name:VIR, MEENA P (MD)
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:P
Last Name:VIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1184
Mailing Address - Country:US
Mailing Address - Phone:920-687-2800
Mailing Address - Fax:920-687-2839
Practice Address - Street 1:200 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-1184
Practice Address - Country:US
Practice Address - Phone:920-687-2800
Practice Address - Fax:920-687-2839
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34681200Medicaid
WI34681200Medicaid
I40461Medicare UPIN