Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | IL | |
N | 208200000X | Surgeon | IL | |
N | 208600000X | Surgeon | IL |
NPI | 1659558732 |
---|---|
Provider Name | Dr. Frederick Karl Merkel |
First Address | Kenilworth, IL 60043-1214 |
Second Address | Kenilworth, IL 60043-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AM3903994 | DEA (01) | |
C-1455 | (02) | IL |